Healthcare Provider Details

I. General information

NPI: 1255787032
Provider Name (Legal Business Name): JONATHAN ZALAMEA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24518 NORTHWEST FWY # 275
CYPRESS TX
77429-2199
US

IV. Provider business mailing address

24518 NORTHWEST FWY # 275
CYPRESS TX
77429-2199
US

V. Phone/Fax

Practice location:
  • Phone: 346-618-4100
  • Fax: 346-618-4101
Mailing address:
  • Phone: 346-618-4100
  • Fax: 346-618-4101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberS3481
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberS3481
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: