Provider Demographics
NPI:1902564008
Name:ZAVALA, NESTOR
Entity Type:Individual
Prefix:
First Name:NESTOR
Middle Name:
Last Name:ZAVALA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 HARVEY AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-2036
Mailing Address - Country:US
Mailing Address - Phone:773-543-1124
Mailing Address - Fax:
Practice Address - Street 1:1808 HARVEY AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2036
Practice Address - Country:US
Practice Address - Phone:773-543-1124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management