Provider Demographics
NPI:1205596897
Name:VALDEZ ZABALA, ANGEL ALEXANDER (CRNA)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:ALEXANDER
Last Name:VALDEZ ZABALA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB.RAFAEL BERMUDEZ
Mailing Address - Street 2:CALLE 8 CASA D 30
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738
Mailing Address - Country:US
Mailing Address - Phone:787-863-1756
Mailing Address - Fax:
Practice Address - Street 1:2140 W 68TH ST STE 300
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1815
Practice Address - Country:US
Practice Address - Phone:305-728-4960
Practice Address - Fax:305-822-5086
Is Sole Proprietor?:No
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR139420367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered