Healthcare Provider Details

I. General information

NPI: 1669911707
Provider Name (Legal Business Name): QUETZALLI ZAVALA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2017
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3326 WATTERS RD BLDG B
PASADENA TX
77504
US

IV. Provider business mailing address

3326 WATTERS RD BLDG B
PASADENA TX
77504-2022
US

V. Phone/Fax

Practice location:
  • Phone: 713-947-9508
  • Fax:
Mailing address:
  • Phone: 713-947-9508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP133242
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: