Healthcare Provider Details

I. General information

NPI: 1407104615
Provider Name (Legal Business Name): MS. DOLORES MARIA ZAVALA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2012
Last Update Date: 08/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 W CHEYENNE AVE SUITE 102
NORTH LAS VEGAS NV
89032-8929
US

IV. Provider business mailing address

4524 VICTORIA GARDEN AVE
NORTH LAS VEGAS NV
89031-0493
US

V. Phone/Fax

Practice location:
  • Phone: 702-631-9251
  • Fax:
Mailing address:
  • Phone: 702-469-1633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: