Healthcare Provider Details

I. General information

NPI: 1457961807
Provider Name (Legal Business Name): LISBETH ESTRADA ZAVALA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2020
Last Update Date: 07/31/2020
Certification Date: 07/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 S PUGET SOUND AVE APT 202
TACOMA WA
98409-4636
US

IV. Provider business mailing address

5714 E G ST
TACOMA WA
98404-2021
US

V. Phone/Fax

Practice location:
  • Phone: 253-988-0475
  • Fax:
Mailing address:
  • Phone: 253-988-0475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License NumberWDL599SCF5SB
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: