Healthcare Provider Details

I. General information

NPI: 1730524331
Provider Name (Legal Business Name): ZAFIRO Q ZAPANTA DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 S BREA CANYON RD
DIAMOND BAR CA
91765-4019
US

IV. Provider business mailing address

2125 S BREA CANYON RD
DIAMOND BAR CA
91765-4019
US

V. Phone/Fax

Practice location:
  • Phone: 909-861-8267
  • Fax: 909-861-8274
Mailing address:
  • Phone: 909-861-8267
  • Fax: 909-861-8274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number40770
License Number StateCA

VIII. Authorized Official

Name: DR. ZAFIRO QUIMSING ZAPANTA
Title or Position: PRESIDENT/CEO
Credential: DDS
Phone: 909-861-8267