Provider Demographics
NPI:1952870081
Name:AVILA ZALDIVAR, ANIELKA (CMA)
Entity Type:Individual
Prefix:
First Name:ANIELKA
Middle Name:
Last Name:AVILA ZALDIVAR
Suffix:
Gender:F
Credentials:CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3840 7TH AVE N
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-2826
Mailing Address - Country:US
Mailing Address - Phone:561-248-5588
Mailing Address - Fax:561-228-0786
Practice Address - Street 1:3840 7TH AVE N
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-2826
Practice Address - Country:US
Practice Address - Phone:561-248-5588
Practice Address - Fax:561-228-0786
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-19
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL140355343900000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL82-4792088OtherPHLEBOTOMIST