Healthcare Provider Details

I. General information

NPI: 1467073684
Provider Name (Legal Business Name): JASMIN ZAPATERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 04/28/2020
Certification Date: 04/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3816 S 74TH DR
PHOENIX AZ
85043-7589
US

IV. Provider business mailing address

3816 S 74TH DR
PHOENIX AZ
85043-7589
US

V. Phone/Fax

Practice location:
  • Phone: 626-665-2943
  • Fax:
Mailing address:
  • Phone: 626-665-2943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: