Healthcare Provider Details

I. General information

NPI: 1699390682
Provider Name (Legal Business Name): JORGE ZATARAIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 06/15/2020
Certification Date: 06/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1358 N NORTHSTAR AVE
COLTON CA
92324-6633
US

IV. Provider business mailing address

14050 CHERRY AVE STE R
FONTANA CA
92337-2002
US

V. Phone/Fax

Practice location:
  • Phone: 951-377-2037
  • Fax:
Mailing address:
  • Phone: 951-377-2037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: