Provider Demographics
NPI:1003894098
Name:ZORRILLA, MIRTA (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRTA
Middle Name:
Last Name:ZORRILLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4937 S JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-7228
Mailing Address - Country:US
Mailing Address - Phone:956-618-2258
Mailing Address - Fax:956-618-2179
Practice Address - Street 1:4937 S JACKSON RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-7228
Practice Address - Country:US
Practice Address - Phone:956-618-2258
Practice Address - Fax:956-618-2179
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ07412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098676202Medicaid
TX00H11SOtherBCBS
TX098676202Medicaid
TX00H11SOtherBCBS