Provider Demographics
NPI:1376937847
Name:ZAVALA, FATIMA MARIA (MS CCC/SLP)
Entity Type:Individual
Prefix:
First Name:FATIMA
Middle Name:MARIA
Last Name:ZAVALA
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 FAIR OAKS DR
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-2038
Mailing Address - Country:US
Mailing Address - Phone:956-522-5494
Mailing Address - Fax:
Practice Address - Street 1:1814 FAIR OAKS DR
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78574-2038
Practice Address - Country:US
Practice Address - Phone:956-522-5494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108814235Z00000X
PASL012008235Z00000X
FLSA12951235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist