Healthcare Provider Details

I. General information

NPI: 1245194992
Provider Name (Legal Business Name): MR. ALFREDO ZAVALA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14300 PEBBLE HILLS BLVD
EL PASO TX
79938-2467
US

IV. Provider business mailing address

14300 PEBBLE HILLS BLVD
EL PASO TX
79938-2467
US

V. Phone/Fax

Practice location:
  • Phone: 915-955-9998
  • Fax:
Mailing address:
  • Phone: 915-955-9998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1219151
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: