Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 002506 | AZ |
NPI | 1013588359 |
---|---|
Provider Name | Gabriel Zelaya |
First Address | Tucson, AZ 85704-5644 |
Second Address | Tucson, AZ 85704-5644 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2021 |
Last Update Date | 08/07/2021 |