Healthcare Provider Details

I. General information

NPI: 1235958141
Provider Name (Legal Business Name): SANDRA S ZAPATA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 E MAIN ST
CENTREVILLE MI
49032-8524
US

IV. Provider business mailing address

9937 BARKER RD
WHITE PIGEON MI
49099-9440
US

V. Phone/Fax

Practice location:
  • Phone: 269-467-1000
  • Fax:
Mailing address:
  • Phone: 269-492-5104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number6851119127
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: