Healthcare Provider Details

I. General information

NPI: 1144295676
Provider Name (Legal Business Name): YVONNE DENISE ZABALA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 S HICKORY ST HOLMES REGIONAL MED CENTER
MELBOURNE FL
32901-3278
US

IV. Provider business mailing address

PO BOX 44008 UFJP PROVIDER ENROLLMENT
JACKSONVILLE FL
32231-4008
US

V. Phone/Fax

Practice location:
  • Phone: 321-434-1491
  • Fax: 321-434-8939
Mailing address:
  • Phone: 904-244-3660
  • Fax: 904-244-3425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOS8328
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: