Provider Demographics
NPI:1962476473
Name:ZAYAS, JOSE A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
Last Name:ZAYAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 CALLE DE DIEGO
Mailing Address - Street 2:404
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00923-3003
Mailing Address - Country:US
Mailing Address - Phone:787-282-8112
Mailing Address - Fax:787-274-1929
Practice Address - Street 1:COND DE DIEGO
Practice Address - Street 2:404
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-3001
Practice Address - Country:US
Practice Address - Phone:787-282-8112
Practice Address - Fax:787-274-1929
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10899174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE49603Medicare UPIN