Healthcare Provider Details

I. General information

NPI: 1669095873
Provider Name (Legal Business Name): JOSE ALEJANDRO ZAVALA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 05/21/2020
Certification Date: 05/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2163 W 73RD ST # 4
HIALEAH FL
33016-5551
US

IV. Provider business mailing address

2163 W 73RD ST # 4
HIALEAH FL
33016-5551
US

V. Phone/Fax

Practice location:
  • Phone: 305-825-3872
  • Fax:
Mailing address:
  • Phone: 305-825-3872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW16080
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: