Healthcare Provider Details

I. General information

NPI: 1891554267
Provider Name (Legal Business Name): JULIA ZAGADA-ALVAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 03/18/2024
Certification Date: 03/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12060 W 77TH TER APT G
LENEXA KS
66216-3338
US

IV. Provider business mailing address

12060 W 77TH TER APT G
LENEXA KS
66216-3338
US

V. Phone/Fax

Practice location:
  • Phone: 913-563-0916
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: