Provider Demographics
NPI:1407389414
Name:PAREJA ZABALA, JOSE FERNANDO
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:FERNANDO
Last Name:PAREJA ZABALA
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 1:2301 SUN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018-2318
Mailing Address - Country:US
Mailing Address - Phone:262-928-4043
Mailing Address - Fax:
Practice Address - Street 1:2301 SUN VALLEY DR
Practice Address - Street 2:
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-2318
Practice Address - Country:US
Practice Address - Phone:262-928-4043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI75540207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program