Healthcare Provider Details

I. General information

NPI: 1205596897
Provider Name (Legal Business Name): ANGEL ALEXANDER VALDEZ ZABALA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2021
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 W 68TH ST STE 300
HIALEAH FL
33016-1815
US

IV. Provider business mailing address

URB.RAFAEL BERMUDEZ CALLE 8 CASA D 30
FAJARDO PR
00738
US

V. Phone/Fax

Practice location:
  • Phone: 305-728-4960
  • Fax: 305-822-5086
Mailing address:
  • Phone: 787-863-1756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number139420
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: