MEDICARE: MR. JUAN CARLOS ZAVALA MASSAGE THERAPIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor	LMT 3032	NM

General Provider Information

NPI Number	:	1427323633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JUAN CARLOS ZAVALA MASSAGE THERAPIST

Provider Business Mailing Address
First Line	:	230 ADAMS STREET
Second Line	:	S.E.
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87108
Country	:	US
Telephone Number	:	505-843-7492
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 ADAMS ST SE
Second Line	:	S.E.
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87108-2805
Country	:	US
Telephone Number	:	505-843-7492
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2012
Last Update Date	:	03/21/2012

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