Provider Demographics
NPI:1275812778
Name:ZAVALETA, ISIDRO
Entity Type:Individual
Prefix:MR
First Name:ISIDRO
Middle Name:
Last Name:ZAVALETA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 SOLUTIONS WAY STE 120
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3623
Mailing Address - Country:US
Mailing Address - Phone:321-635-9535
Mailing Address - Fax:321-635-9171
Practice Address - Street 1:590 SOLUTIONS WAY STE 120
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3623
Practice Address - Country:US
Practice Address - Phone:321-635-9535
Practice Address - Fax:321-635-9171
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst