Healthcare Provider Details

I. General information

NPI: 1275736373
Provider Name (Legal Business Name): JACQUELINE ALEXANDRA ZAPP-GARCIA C.P.M., L.D.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5414 N MONTANA AVE
PORTLAND OR
97217-4568
US

IV. Provider business mailing address

5414 N MONTANA AVE
PORTLAND OR
97217-4568
US

V. Phone/Fax

Practice location:
  • Phone: 971-570-0688
  • Fax: 503-247-8053
Mailing address:
  • Phone: 971-570-0688
  • Fax: 503-247-8053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License NumberDEM-LD-10117448
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: