Healthcare Provider Details

I. General information

NPI: 1720693930
Provider Name (Legal Business Name): MRS. ETHEL ISABEL ZAPATA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8292 CALABRIA LAKES DR
BOYNTON BEACH FL
33473-4944
US

IV. Provider business mailing address

8292 CALABRIA LAKES DR
BOYNTON BEACH FL
33473-4944
US

V. Phone/Fax

Practice location:
  • Phone: 786-547-9224
  • Fax:
Mailing address:
  • Phone: 786-547-9224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA94703
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: