Healthcare Provider Details

I. General information

NPI: 1568277028
Provider Name (Legal Business Name): NANCI ZAVALETA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 02/11/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 CAMINO LA COSTA
AUSTIN TX
78752-3930
US

IV. Provider business mailing address

1101 CAMINO LA COSTA
AUSTIN TX
78752-3930
US

V. Phone/Fax

Practice location:
  • Phone: 512-684-1799
  • Fax:
Mailing address:
  • Phone: 512-684-1799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number11936
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: