Healthcare Provider Details

I. General information

NPI: 1275256166
Provider Name (Legal Business Name): JORDAN ZAVALA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 09/26/2022
Certification Date: 09/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10050 RALSTON RD # 1
ARVADA CO
80004-4974
US

IV. Provider business mailing address

11309 E 25TH DR
AURORA CO
80010-1267
US

V. Phone/Fax

Practice location:
  • Phone: 720-583-6145
  • Fax:
Mailing address:
  • Phone: 703-963-8225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0998022
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: