Healthcare Provider Details

I. General information

NPI: 1174476592
Provider Name (Legal Business Name): VICTOR EDUARDO ZAPATA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17652 HERITAGE HWY
DENMARK SC
29042-1469
US

IV. Provider business mailing address

4282 CANDLEBERRY GDN
NORTH AUGUSTA SC
29860-7202
US

V. Phone/Fax

Practice location:
  • Phone: 803-793-3653
  • Fax:
Mailing address:
  • Phone: 714-773-2698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11504
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: