Provider Demographics
NPI:1992437396
Name:ZALDIVAR AGUILAR, ROBERTO MARCELO
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:MARCELO
Last Name:ZALDIVAR AGUILAR
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 1:4401 GARTH RD
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-2122
Mailing Address - Country:US
Mailing Address - Phone:281-420-8600
Mailing Address - Fax:
Practice Address - Street 1:9831 S GALWAN CIR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-9201
Practice Address - Country:US
Practice Address - Phone:346-376-1380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-26
Last Update Date:2022-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16-648246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXNAOtherSURGICAL ASSISTANT