Healthcare Provider Details

I. General information

NPI: 1710488382
Provider Name (Legal Business Name): MARIO DANIEL ZAPATA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 02/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 TULIP CIR
ALAMO TX
78516-9806
US

IV. Provider business mailing address

520 TULIP CIR
ALAMO TX
78516-9806
US

V. Phone/Fax

Practice location:
  • Phone: 956-821-1735
  • Fax:
Mailing address:
  • Phone: 956-821-1735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number212920
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: