MEDICARE: ERNESTO ZAVALETA, MD, PA

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	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649268202
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERNESTO ZAVALETA, MD, PA

Provider Business Mailing Address
First Line	:	P.O. BOX 783247
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34778
Country	:	US
Telephone Number	:	352-241-9322
Fax Number	:

Provider Business Practice Location Address
First Line	:	1099 CITRUS TOWER BLVD
Second Line	:	SOUTH LAKE HOSPITAL
City	:	CLERMONT
State	:	FL
Zip	:	34711
Country	:	US
Telephone Number	:	352-241-9322
Fax Number	:	352-241-9107

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ERNESTO G ZAVALETA
Credential	:	MD
Telephone Number	:	352-241-9322

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	03/24/2010

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