Provider Demographics
NPI:1225032113
Name:ZAVALETA, BEVERLY A (MD)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:A
Last Name:ZAVALETA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:E
Other - Last Name:AIST-MEJIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:512 VICTORIA LN STE 12
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-3228
Mailing Address - Country:US
Mailing Address - Phone:956-440-6300
Mailing Address - Fax:888-698-3908
Practice Address - Street 1:512 VICTORIA LN STE 12
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-3228
Practice Address - Country:US
Practice Address - Phone:956-440-6300
Practice Address - Fax:888-698-3908
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5643207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1613481-01Medicaid
TX161350706Medicaid
TXH90504Medicare UPIN
TX161350706Medicaid