Provider Demographics
NPI:1245878347
Name:ZABALA, EDAGAR FLAMINIO
Entity type:Individual
Prefix:
First Name:EDAGAR
Middle Name:FLAMINIO
Last Name:ZABALA
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 1:4516 NW 114TH AVE APT 2012
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-4803
Mailing Address - Country:US
Mailing Address - Phone:321-682-9674
Mailing Address - Fax:
Practice Address - Street 1:4516 NW 114TH AVE APT 2012
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-4803
Practice Address - Country:US
Practice Address - Phone:321-682-9674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator