Healthcare Provider Details

I. General information

NPI: 1295515443
Provider Name (Legal Business Name): JOSE ZAPATA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2023
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2677 ZOE AVE STE 304
HUNTINGTON PARK CA
90255-3699
US

IV. Provider business mailing address

2677 ZOE AVE STE 304
HUNTINGTON PARK CA
90255-3699
US

V. Phone/Fax

Practice location:
  • Phone: 323-346-0960
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-TCELSZ
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: