Provider Demographics
NPI:1770010126
Name:OVALLES, TIRZA PAOLA (MD)
Entity type:Individual
Prefix:MRS
First Name:TIRZA
Middle Name:PAOLA
Last Name:OVALLES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2433 ACADEMY CIR E APT 306
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-8510
Mailing Address - Country:US
Mailing Address - Phone:407-350-8013
Mailing Address - Fax:
Practice Address - Street 1:2433 ACADEMY CIR E APT 306
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-8510
Practice Address - Country:US
Practice Address - Phone:407-350-8013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
0005806905OtherMOLINA HEALTHCARE