Healthcare Provider Details

I. General information

NPI: 1144982836
Provider Name (Legal Business Name): JACQUELINE VIRGINIA ZOLAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2021
Last Update Date: 10/10/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4638 RIVERSTONE BLVD
MISSOURI CITY TX
77459-6157
US

IV. Provider business mailing address

12525 S KIRKWOOD RD APT 3
STAFFORD TX
77477-2831
US

V. Phone/Fax

Practice location:
  • Phone: 281-969-7527
  • Fax:
Mailing address:
  • Phone: 832-409-9634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: