Healthcare Provider Details

I. General information

NPI: 1477185783
Provider Name (Legal Business Name): MRS. LIZ SAMARA ZAPATA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18644 SINGLETARY LN
MIAMI FL
33194-2708
US

IV. Provider business mailing address

18644 SINGLETARY LN
MIAMI FL
33194-2708
US

V. Phone/Fax

Practice location:
  • Phone: 786-848-5342
  • Fax:
Mailing address:
  • Phone: 786-848-5342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-92161
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: