Healthcare Provider Details

I. General information

NPI: 1275995771
Provider Name (Legal Business Name): PEDRO ZAVALA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 THOUSAND OAKS DR
SAN ANTONIO TX
78217-2152
US

IV. Provider business mailing address

3750 COMMERCIAL AVE
SAN ANTONIO TX
78221-3117
US

V. Phone/Fax

Practice location:
  • Phone: 210-922-7000
  • Fax: 210-924-1374
Mailing address:
  • Phone: 210-922-7000
  • Fax: 210-924-1374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberS1319
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: