Provider Demographics
NPI:1639618366
Name:ZAVALA, ROSA (RN)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:ZAVALA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5436 W GROVE ST
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-1500
Mailing Address - Country:US
Mailing Address - Phone:602-752-7315
Mailing Address - Fax:
Practice Address - Street 1:1100 N 35TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-5210
Practice Address - Country:US
Practice Address - Phone:602-381-4665
Practice Address - Fax:602-381-4662
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN169281163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse