Provider Demographics
NPI:1932688843
Name:ZAVALA, CRYSTAL MABEL (LVN)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:MABEL
Last Name:ZAVALA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 MCKINNEY ST
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77801-1443
Mailing Address - Country:US
Mailing Address - Phone:979-317-9696
Mailing Address - Fax:
Practice Address - Street 1:4030 HIGHWAY 6 S STE 150
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-1808
Practice Address - Country:US
Practice Address - Phone:979-431-3380
Practice Address - Fax:979-690-1008
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX344143164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse