Healthcare Provider Details

I. General information

NPI: 1083287627
Provider Name (Legal Business Name): ELIZABET ZAPATA ROMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35800 BOB HOPE DR STE 100
RANCHO MIRAGE CA
92270-1739
US

IV. Provider business mailing address

1305 N MARTIN AVE
TUCSON AZ
85721-0001
US

V. Phone/Fax

Practice location:
  • Phone: 760-902-0522
  • Fax:
Mailing address:
  • Phone: 760-902-0522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95002443
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95107744
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: