Basic Information
| Provider Information | |||||||||
| NPI: | 1730540261 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZAVALA | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | MANUEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DNP, APRN, FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1485 GEORGE DIETER DR | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799367650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9157905700 | ||||||||
| FaxNumber: | 9157905727 | ||||||||
| Practice Location | |||||||||
| Address1: | 1485 GEORGE DIETER DR | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799367650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9157905700 | ||||||||
| FaxNumber: | 9157905727 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2016 | ||||||||
| LastUpdateDate: | 01/28/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP130544 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.