Healthcare Provider Details

I. General information

NPI: 1992856033
Provider Name (Legal Business Name): MARIO GUILLERMO ZAPATA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 BROOKDALE DR
STATESVILLE NC
28677-4107
US

IV. Provider business mailing address

515 BROOKDALE DR
STATESVILLE NC
28677-4107
US

V. Phone/Fax

Practice location:
  • Phone: 704-883-8660
  • Fax: 704-883-8661
Mailing address:
  • Phone: 704-883-8660
  • Fax: 704-883-8661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number200200086
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: