Provider Demographics
NPI:1801042577
Name:ZAVALA, SERGIO MORENO (PHARMD)
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:MORENO
Last Name:ZAVALA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3354 W ORANGE AVE APT 54
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-6818
Mailing Address - Country:US
Mailing Address - Phone:714-296-3598
Mailing Address - Fax:
Practice Address - Street 1:3354 W ORANGE AVE APT 54
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-6818
Practice Address - Country:US
Practice Address - Phone:714-296-3598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58054183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist