Basic Information
Provider Information
NPI: 1558842963
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ZAVALA
FirstName: MARGARITA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3544 KAGAN CT
Address2:  
City: N LAS VEGAS
State: NV
PostalCode: 890814026
CountryCode: US
TelephoneNumber: 7024261622
FaxNumber:  
Practice Location
Address1: 160 E HORIZON DR STE A
Address2:  
City: HENDERSON
State: NV
PostalCode: 890157934
CountryCode: US
TelephoneNumber: 7026443600
FaxNumber: 7027195665
Other Information
ProviderEnumerationDate: 08/23/2018
LastUpdateDate: 08/23/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
372600000X NVN Nursing Service Related ProvidersAdult Companion 
3747A0650X NVN Nursing Service Related ProvidersTechnicianAttendant Care Provider
376J00000X NVN Nursing Service Related ProvidersHomemaker 
3747P1801X NVY Nursing Service Related ProvidersTechnicianPersonal Care Attendant

No ID Information.


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