Provider Demographics
NPI:1457572331
Name:ZAYAS, VIDAMARIS (2544)
Entity Type:Individual
Prefix:DR
First Name:VIDAMARIS
Middle Name:
Last Name:ZAYAS
Suffix:
Gender:F
Credentials:2544
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE CRUZ ORTIZ STELLA #64
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791
Mailing Address - Country:US
Mailing Address - Phone:787-852-1875
Mailing Address - Fax:787-850-7344
Practice Address - Street 1:VIDAMARIS ZAYAS CALLE CRUZ ORTIZ STELLA #64
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-852-1875
Practice Address - Fax:787-850-7344
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2544174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist