Healthcare Provider Details

I. General information

NPI: 1174002158
Provider Name (Legal Business Name): BRANDON ZAVALA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2904 S JACKSON RD
MCALLEN TX
78503-1870
US

IV. Provider business mailing address

2904 S JACKSON RD
MCALLEN TX
78503-1870
US

V. Phone/Fax

Practice location:
  • Phone: 956-631-8646
  • Fax:
Mailing address:
  • Phone: 956-631-8646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number214793
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: