Healthcare Provider Details

I. General information

NPI: 1659657344
Provider Name (Legal Business Name): ARMANDO JESUS ZAPATA CADC-II A018190315
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2011
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

658 BRIER ST
SAN BERNARDINO CA
92415-3934
US

IV. Provider business mailing address

11133 DAYLILLY ST
FONTANA CA
92337-6829
US

V. Phone/Fax

Practice location:
  • Phone: 909-252-5402
  • Fax:
Mailing address:
  • Phone: 190-926-8275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberI9660610
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberA018190315
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: