Healthcare Provider Details

I. General information

NPI: 1407218936
Provider Name (Legal Business Name): JOSE A ZEPEDA FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 OCOTILLO DR STE B
EL CENTRO CA
92243-4251
US

IV. Provider business mailing address

1501 OCOTILLO DR STE C
EL CENTRO CA
92243-4217
US

V. Phone/Fax

Practice location:
  • Phone: 619-334-4869
  • Fax: 619-334-4940
Mailing address:
  • Phone: 760-353-6363
  • Fax: 760-353-0630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number95003783
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95003783
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: