Healthcare Provider Details

I. General information

NPI: 1558940486
Provider Name (Legal Business Name): CYNTHIA BERTHA ZEVALLOS MAU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 W 18TH ST STE 100
SIOUX FALLS SD
57104-4650
US

IV. Provider business mailing address

200 HAWKINS DR
IOWA CITY IA
52242-1009
US

V. Phone/Fax

Practice location:
  • Phone: 605-357-1367
  • Fax:
Mailing address:
  • Phone: 319-467-5463
  • Fax: 319-384-8114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberR-12027
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0762
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: