Provider Demographics
NPI:1669630737
Name:COLATO ZAVALETA, FERNANDO JOSE
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:JOSE
Last Name:COLATO ZAVALETA
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:PO BOX 674098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-4098
Mailing Address - Country:US
Mailing Address - Phone:979-774-4008
Mailing Address - Fax:
Practice Address - Street 1:2700 E 29TH ST STE 220
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2586
Practice Address - Country:US
Practice Address - Phone:979-774-4008
Practice Address - Fax:979-731-8418
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP9061207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease