Healthcare Provider Details

I. General information

NPI: 1023038155
Provider Name (Legal Business Name): JOHN J ZAVALETA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 N MACARTHUR BLVD STE 350
IRVING TX
75062-3636
US

IV. Provider business mailing address

3501 N MACARTHUR BLVD STE 350
IRVING TX
75062-3636
US

V. Phone/Fax

Practice location:
  • Phone: 972-257-5300
  • Fax: 972-257-5321
Mailing address:
  • Phone: 972-257-5300
  • Fax: 972-257-5321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberG0320
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: