Provider Demographics
NPI:1205489655
Name:ZAVALA VASQUEZ, ROSA E I
Entity type:Individual
Prefix:MS
First Name:ROSA
Middle Name:E
Last Name:ZAVALA VASQUEZ
Suffix:I
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ROSA
Other - Middle Name:ESTHER
Other - Last Name:ZAVALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3820 TREMAYNE TER
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-2658
Mailing Address - Country:US
Mailing Address - Phone:571-494-3246
Mailing Address - Fax:
Practice Address - Street 1:3064 STANTON RD SE APT 102
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-7888
Practice Address - Country:US
Practice Address - Phone:202-372-5241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD11357477050Medicaid