Provider Demographics
NPI:1437122835
Name:ZAVALA, DAMON C (DO)
Entity Type:Individual
Prefix:
First Name:DAMON
Middle Name:C
Last Name:ZAVALA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 MT. ROSE ST.
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-3363
Mailing Address - Country:US
Mailing Address - Phone:775-507-7024
Mailing Address - Fax:775-787-0694
Practice Address - Street 1:595 MT. ROSE ST.
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-3363
Practice Address - Country:US
Practice Address - Phone:775-507-7024
Practice Address - Fax:775-787-0694
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV992207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV844039050OtherPRIVATE
NV002016906Medicaid
11042316OtherCAQH
NV002016906Medicaid