Provider Demographics
NPI:1437680253
Name:ZAVALA, JOSE
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:ZAVALA
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 1:5 CALLE DUFRESNE E
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-3605
Mailing Address - Country:US
Mailing Address - Phone:787-852-2470
Mailing Address - Fax:787-285-8093
Practice Address - Street 1:216 VILLA UNIVERSITARIA
Practice Address - Street 2:VILLA STATION
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3605
Practice Address - Country:US
Practice Address - Phone:787-852-2470
Practice Address - Fax:787-285-8093
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR243156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician