Healthcare Provider Details

I. General information

NPI: 1821579277
Provider Name (Legal Business Name): RACEL FERNANDEZ ZAPANTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2018
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 SHELBY DR
LOS ANGELES CA
90034-2725
US

IV. Provider business mailing address

123 S VENDOME ST
LOS ANGELES CA
90057-1115
US

V. Phone/Fax

Practice location:
  • Phone: 833-947-3826
  • Fax:
Mailing address:
  • Phone: 432-271-6288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number298143
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1221867
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: