Healthcare Provider Details

I. General information

NPI: 1003799073
Provider Name (Legal Business Name): MEZTLI SHAIL ZAPATA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 W ALMA AVE
SAN JOSE CA
95110-3631
US

IV. Provider business mailing address

2001 GATEWAY PL STE 230
SAN JOSE CA
95110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 408-708-8875
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: