Healthcare Provider Details

I. General information

NPI: 1053587493
Provider Name (Legal Business Name): DARIO ZAPATA PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14701 NW 77TH AVE
MIAMI LAKES FL
33014-2500
US

IV. Provider business mailing address

5901 SW 59TH ST SUITE 202
SOUTH MIAMI FL
33143-2220
US

V. Phone/Fax

Practice location:
  • Phone: 305-665-4614
  • Fax:
Mailing address:
  • Phone: 305-665-4614
  • Fax: 305-667-0239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9103082
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: