Provider Demographics
NPI:1093035776
Name:ANGELES LAI ZAYAS
Entity Type:Organization
Organization Name:ANGELES LAI ZAYAS
Other - Org Name:ANGELES LAI ZAYAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARILYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOBLADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-947-9508
Mailing Address - Street 1:3326 WATTERS RD
Mailing Address - Street 2:BLG. B
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-2020
Mailing Address - Country:US
Mailing Address - Phone:713-947-9508
Mailing Address - Fax:
Practice Address - Street 1:3326 WATTERS RD
Practice Address - Street 2:BLG. B
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-2020
Practice Address - Country:US
Practice Address - Phone:713-947-9508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-04
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7671207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098510302Medicaid
TX00G568Medicare PIN
TXC18093Medicare UPIN