Healthcare Provider Details

I. General information

NPI: 1508687567
Provider Name (Legal Business Name): JOHN ANTHONY ZAPATA CAPRC, CPSP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6774 RIO GRANDE AVE
PORTAGE IN
46368-2592
US

IV. Provider business mailing address

6774 RIO GRANDE AVE
PORTAGE IN
46368-2592
US

V. Phone/Fax

Practice location:
  • Phone: 219-939-4187
  • Fax:
Mailing address:
  • Phone: 219-689-2153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberCAPRC1-5741
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number4156
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: