=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508594276
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ZENDEVA INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2022
-----------------------------------------------------
Last Update Date | 06/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1005 CONGRESS AVE STE 925-B72
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78701-2463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-585-9497
-----------------------------------------------------
Fax | 361-724-3322
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 271943
-----------------------------------------------------
City | CORPUS CHRISTI
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78427-1943
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-585-9497
-----------------------------------------------------
Fax | 361-724-3322
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ANITA RAQUEL PADILLA
-----------------------------------------------------
Credential | PMHNP-BC
-----------------------------------------------------
Telephone | 361-453-6990
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------