Healthcare Provider Details

I. General information

NPI: 1730920257
Provider Name (Legal Business Name): XIMENA L ZAPATA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2024
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N PARK RD
HOLLYWOOD FL
33021-6917
US

IV. Provider business mailing address

6511 MOSELEY ST
HOLLYWOOD FL
33024-4006
US

V. Phone/Fax

Practice location:
  • Phone: 954-925-3191
  • Fax:
Mailing address:
  • Phone: 954-391-3250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberZ130952989250
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: