Provider Demographics
NPI:1457562563
Name:ZAVALA, IRIS ZORAIDA (PHD)
Entity Type:Individual
Prefix:DR
First Name:IRIS
Middle Name:ZORAIDA
Last Name:ZAVALA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BO. ROSARIO ALTO
Mailing Address - Street 2:HC 1 BUZON 10483
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683
Mailing Address - Country:US
Mailing Address - Phone:787-376-4607
Mailing Address - Fax:
Practice Address - Street 1:CENTRO DE SALUD MENTAL DE MAYAGUEZ
Practice Address - Street 2:410 AVE. HOSTOS SUITE 7
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-1522
Practice Address - Country:US
Practice Address - Phone:787-831-3714
Practice Address - Fax:787-831-2095
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR588103TC0700X
MA3800103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical