Healthcare Provider Details

I. General information

NPI: 1184668618
Provider Name (Legal Business Name): JUAN ZAPATA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12797 FOREST HILL BLVD STE B
WELLINGTON FL
33414-4763
US

IV. Provider business mailing address

15895 MEADOWLARK CT
LOX FL
33470-7008
US

V. Phone/Fax

Practice location:
  • Phone: 561-467-5232
  • Fax:
Mailing address:
  • Phone: 239-470-5539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME115658
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: