Provider Demographics
NPI:1174788418
Name:ZAVALETA, MARY ELIZABETH (ITDS)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELIZABETH
Last Name:ZAVALETA
Suffix:
Gender:F
Credentials:ITDS
Other - Prefix:
Other - First Name:MOLLIE
Other - Middle Name:
Other - Last Name:NEWCOMBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1505 FORT CLARKE BLVD
Mailing Address - Street 2:APARTMENT 5102
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-7182
Mailing Address - Country:US
Mailing Address - Phone:512-775-2868
Mailing Address - Fax:
Practice Address - Street 1:1505 FORT CLARKE BLVD
Practice Address - Street 2:APARTMENT 5102
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-7182
Practice Address - Country:US
Practice Address - Phone:512-775-2868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor