Healthcare Provider Details

I. General information

NPI: 1437680253
Provider Name (Legal Business Name): JOSE ZAVALA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 VILLA UNIVERSITARIA VILLA STATION
HUMACAO PR
00791-3605
US

IV. Provider business mailing address

5 CALLE DUFRESNE E
HUMACAO PR
00791-3605
US

V. Phone/Fax

Practice location:
  • Phone: 787-852-2470
  • Fax: 787-285-8093
Mailing address:
  • Phone: 787-852-2470
  • Fax: 787-285-8093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number243
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: