Provider Demographics
NPI:1932750197
Name:ZAVALA MORE, VICTOR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:
Last Name:ZAVALA MORE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2604 MCINTOSH RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-3934
Mailing Address - Country:US
Mailing Address - Phone:941-306-7594
Mailing Address - Fax:
Practice Address - Street 1:200 3RD AVE W STE 100
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-8628
Practice Address - Country:US
Practice Address - Phone:941-792-0340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9112501363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty