Provider Demographics
NPI:1205017084
Name:LIVANIA ZAVALA-SPINETTI MD PA
Entity Type:Organization
Organization Name:LIVANIA ZAVALA-SPINETTI MD PA
Other - Org Name:EDINBURG CHILDREN'S CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIVANIA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:ZAVALA-SPINETTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-682-4500
Mailing Address - Street 1:4709 S JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-8381
Mailing Address - Country:US
Mailing Address - Phone:956-682-4500
Mailing Address - Fax:956-682-4505
Practice Address - Street 1:4709 S JACKSON RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8381
Practice Address - Country:US
Practice Address - Phone:956-682-4500
Practice Address - Fax:956-682-4505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1251208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164864403Medicaid
TX1887739-02Medicaid