Basic Information
| Provider Information | |||||||||
| NPI: | 1033362173 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ZEBALLOS HEALTHCARE | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | INTERVENTIONAL SPINE AND PAIN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12221 MERIT DR STE 620 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752513222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2145062612 | ||||||||
| FaxNumber: | 9726818727 | ||||||||
| Practice Location | |||||||||
| Address1: | 17051 DALLAS PKWY STE 300 | ||||||||
| Address2: | |||||||||
| City: | ADDISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750017105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2148883900 | ||||||||
| FaxNumber: | 2148883901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2008 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | ZEBALLOS | ||||||||
| AuthorizedOfficialFirstName: | PABLO | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2143455756 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7083350001 | 01 | TX | NSC-DME | OTHER | 0081RX | 01 | TX | BCBS | OTHER |