Healthcare Provider Details

I. General information

NPI: 1033773593
Provider Name (Legal Business Name): HECTOR JORDAN ZAYAS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 10/07/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 S TYLER ST
COVINGTON LA
70433-2330
US

IV. Provider business mailing address

39239 Z OAKS LN
PONCHATOULA LA
70454-4605
US

V. Phone/Fax

Practice location:
  • Phone: 985-898-4583
  • Fax: 985-898-4394
Mailing address:
  • Phone: 985-320-8476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN136074
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number120488
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number226730
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: