Provider Demographics
NPI:1275550360
Name:LAS COLINAS OBSTETRICS GYNECOLOGY & INFERTILITY ASSOCIATION P A
Entity Type:Organization
Organization Name:LAS COLINAS OBSTETRICS GYNECOLOGY & INFERTILITY ASSOCIATION P A
Other - Org Name:LAS COLINAS OBSTETRICS GYNECOLOGY INFERTILITY ASSOCIATION PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZAVALETA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-257-5300
Mailing Address - Street 1:3501 N. MACARTHUR BLVD.
Mailing Address - Street 2:STE. 350
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-3600
Mailing Address - Country:US
Mailing Address - Phone:972-257-5300
Mailing Address - Fax:972-257-5322
Practice Address - Street 1:3501 N. MACARTHUR BLVD.
Practice Address - Street 2:STE. 350
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-3600
Practice Address - Country:US
Practice Address - Phone:972-257-5300
Practice Address - Fax:972-257-5320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0320207V00000X
TXJ3676207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114823103Medicaid
B27801Medicare UPIN
TX00Z869Medicare PIN