Provider Demographics
NPI:1629413125
Name:HILBERT ZEBALLOS PA
Entity Type:Organization
Organization Name:HILBERT ZEBALLOS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HILBERT
Authorized Official - Middle Name:CICERON
Authorized Official - Last Name:ZEBALLOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-208-1883
Mailing Address - Street 1:903 BALMORAL WAY
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-2402
Mailing Address - Country:US
Mailing Address - Phone:321-208-1883
Mailing Address - Fax:321-208-1883
Practice Address - Street 1:903 BALMORAL WAY
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2402
Practice Address - Country:US
Practice Address - Phone:321-208-1883
Practice Address - Fax:321-208-1883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90229207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI-00580Medicare UPIN