Provider Demographics
NPI:1699820860
Name:BEVERLY A ZAVALETA, MD PA
Entity Type:Organization
Organization Name:BEVERLY A ZAVALETA, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZAVALETA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-798-9355
Mailing Address - Street 1:PO BOX 380465
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78268-7465
Mailing Address - Country:US
Mailing Address - Phone:210-798-9355
Mailing Address - Fax:210-798-9356
Practice Address - Street 1:9355 BANDERA RD
Practice Address - Street 2:STE. 136
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-2562
Practice Address - Country:US
Practice Address - Phone:210-798-9355
Practice Address - Fax:210-798-9356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5643207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH90504Medicare UPIN
TX00531VMedicare ID - Type UnspecifiedGROUP#