Healthcare Provider Details

I. General information

NPI: 1225761711
Provider Name (Legal Business Name): CESAR LUIS ZAVALA-RODRIGUEZ MAT, LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2022
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 TIGER DR
MORGAN CITY LA
70380-1051
US

IV. Provider business mailing address

301 GRIZZAFFI ST TRLR 31
MORGAN CITY LA
70380-2361
US

V. Phone/Fax

Practice location:
  • Phone: 985-384-1754
  • Fax:
Mailing address:
  • Phone: 985-255-8065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: