Provider Demographics
NPI:1720160351
Name:RACASA-ALIYAS, ZENAIDA P (MD)
Entity Type:Individual
Prefix:DR
First Name:ZENAIDA
Middle Name:P
Last Name:RACASA-ALIYAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 N MAIN ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76106-8570
Mailing Address - Country:US
Mailing Address - Phone:817-625-4254
Mailing Address - Fax:817-625-8451
Practice Address - Street 1:2106 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76106-8511
Practice Address - Country:US
Practice Address - Phone:817-625-4254
Practice Address - Fax:817-625-8451
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9926208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0000LR93Medicaid
E17546Medicare UPIN