Provider Demographics
NPI:1558318378
Name:ZARZUELA, ALYKHYM BUENTIPO (DO)
Entity Type:Individual
Prefix:DR
First Name:ALYKHYM
Middle Name:BUENTIPO
Last Name:ZARZUELA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:KHYM
Other - Middle Name:BUENTIPO
Other - Last Name:ZARZUELA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1510 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006
Mailing Address - Country:US
Mailing Address - Phone:830-816-4357
Mailing Address - Fax:830-331-8718
Practice Address - Street 1:1510 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006
Practice Address - Country:US
Practice Address - Phone:830-816-4357
Practice Address - Fax:830-331-8718
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6289207Q00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX263182ZG9WMedicare PIN
TX263182ZNSCMedicare PIN
TXF73095Medicare UPIN
TX263182ZSWSMedicare PIN
TX124494908Medicaid
TX263182ZNSCMedicare PIN