Healthcare Provider Details

I. General information

NPI: 1558002626
Provider Name (Legal Business Name): MAYRA ZAPOTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 04/05/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 HARRY HINES BLVD FL 3
DALLAS TX
75235-7709
US

IV. Provider business mailing address

4743 NEEDLE LEAF LN
DALLAS TX
75236-2161
US

V. Phone/Fax

Practice location:
  • Phone: 214-590-8000
  • Fax:
Mailing address:
  • Phone: 469-554-6817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number1074200
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: