Healthcare Provider Details

I. General information

NPI: 1548016777
Provider Name (Legal Business Name): MIANA RENE ZAPATA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 04/29/2024
Certification Date: 04/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 PEASE ST
HARLINGEN TX
78550-8307
US

IV. Provider business mailing address

23080 HIGHWAY 16 S
VON ORMY TX
78073-5362
US

V. Phone/Fax

Practice location:
  • Phone: 956-389-1100
  • Fax:
Mailing address:
  • Phone: 210-364-6655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberBP10087934
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: