Healthcare Provider Details

I. General information

NPI: 1811355316
Provider Name (Legal Business Name): OSCAR MORA ZAVALA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2016
Last Update Date: 02/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 S 7TH ST
TERRE HAUTE IN
47802-5709
US

IV. Provider business mailing address

3901 S 7TH ST
TERRE HAUTE IN
47802-5709
US

V. Phone/Fax

Practice location:
  • Phone: 801-458-2001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28228204A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: