Provider Demographics
NPI:1063279412
Name:ROJAS ZABALA, JOSE OMAR
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:OMAR
Last Name:ROJAS 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 1:13 TEMPLE ST
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01832-5412
Mailing Address - Country:US
Mailing Address - Phone:978-476-3501
Mailing Address - Fax:
Practice Address - Street 1:13 TEMPLE ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01832-5412
Practice Address - Country:US
Practice Address - Phone:978-476-3501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver