Healthcare Provider Details

I. General information

NPI: 1629351929
Provider Name (Legal Business Name): MR. JEREMIAH CRISOLOGO ZAPANTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 09/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USS GUARDIAN
FPO AP
96666-1925
US

IV. Provider business mailing address

USS GUARDIAN MCM 5
FPO AP
96666-1925
US

V. Phone/Fax

Practice location:
  • Phone: 315-252-1292
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: