Healthcare Provider Details

I. General information

NPI: 1407287808
Provider Name (Legal Business Name): LUIS ZAPPA VALLE CSA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2013
Last Update Date: 12/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RESEARCH CT SU 450
ROCKVILLE MD
20850-3221
US

IV. Provider business mailing address

1 RESEARCH CT SU 450
ROCKVILLE MD
20850-3221
US

V. Phone/Fax

Practice location:
  • Phone: 240-403-4067
  • Fax: 301-929-0798
Mailing address:
  • Phone: 240-403-4067
  • Fax: 301-929-0798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberSA0041
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: