Healthcare Provider Details

I. General information

NPI: 1639990088
Provider Name (Legal Business Name): MARIA EUGENIA ZABALETA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 N JACKSON RD
PHARR TX
78577-7768
US

IV. Provider business mailing address

CAKE ARCO IRIS N 155
FRACCIONAMIENTO NUEVO PROGRESO TAMAULIPAS
88123
MX

V. Phone/Fax

Practice location:
  • Phone: 956-375-4695
  • Fax: 956-375-4695
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6161072
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: