Provider Demographics
NPI:1447885835
Name:ZALDIVAR, JOSE M (PA)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:M
Last Name:ZALDIVAR
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19562 NW 79TH PL
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-6338
Mailing Address - Country:US
Mailing Address - Phone:786-286-6465
Mailing Address - Fax:
Practice Address - Street 1:19562 NW 79TH PL
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-6338
Practice Address - Country:US
Practice Address - Phone:786-286-6465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001013363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant