Provider Demographics
NPI:1457961807
Name:ZAVALA, LISBETH ESTRADA
Entity type:Individual
Prefix:
First Name:LISBETH
Middle Name:ESTRADA
Last Name:ZAVALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5714 E G ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98404-2021
Mailing Address - Country:US
Mailing Address - Phone:253-988-0475
Mailing Address - Fax:
Practice Address - Street 1:4020 S PUGET SOUND AVE APT 202
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-4636
Practice Address - Country:US
Practice Address - Phone:253-988-0475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWDL599SCF5SB171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171R00000XOther Service ProvidersInterpreterGroup - Single Specialty