Provider Demographics
NPI:1952405391
Name:ZAVALA, MANUEL ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:ANTONIO
Last Name:ZAVALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 CALLE CROSANDRA
Mailing Address - Street 2:PARQUE DE BUCARE
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5102
Mailing Address - Country:US
Mailing Address - Phone:787-720-1204
Mailing Address - Fax:787-767-8783
Practice Address - Street 1:CALLE RVDO. DOMINGO MARRERO NAVARRO #5
Practice Address - Street 2:STA. RITA
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00925
Practice Address - Country:US
Practice Address - Phone:787-767-7586
Practice Address - Fax:787-767-8783
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12028207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine