MEDICARE: RICHARD ZAVALLA AGNP-C

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	163WC0200X	Critical Care Medicine Registered Nurse	786186	TX
2	363LA2200X	Adult Health Nurse Practitioner	AP127748	TX

General Provider Information

NPI Number	:	1477933893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD ZAVALLA AGNP-C

Provider Business Mailing Address
First Line	:	11221 KATY FWY STE 115
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77079-2105
Country	:	US
Telephone Number	:	281-600-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	11221 KATY FWY STE 115
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77079-2105
Country	:	US
Telephone Number	:	800-991-6117
Fax Number	:	888-812-8191

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

Provider Enumeration Date	:	06/01/2015
Last Update Date	:	05/01/2025

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