Provider Demographics
NPI:1689034654
Name:ZAVALA-SALAS, WALTER XAVIER (RPA-C)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:XAVIER
Last Name:ZAVALA-SALAS
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:DR
Other - First Name:WALTER
Other - Middle Name:XAVIER
Other - Last Name:ZAVALA-SALAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 666
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-0666
Mailing Address - Country:US
Mailing Address - Phone:347-867-9059
Mailing Address - Fax:
Practice Address - Street 1:593 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457
Practice Address - Country:US
Practice Address - Phone:347-867-9059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-03
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150625246RP1900X
NY23019512363A00000X, 363AM0700X
NY019512-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant