Healthcare Provider Details

I. General information

NPI: 1245002989
Provider Name (Legal Business Name): ZAPATA PRIMARY CARE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2023
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S US HIGHWAY 83
ZAPATA TX
78076-3747
US

IV. Provider business mailing address

7521 COUNTRY CLUB DR APT 506
LAREDO TX
78041-3398
US

V. Phone/Fax

Practice location:
  • Phone: 956-750-3429
  • Fax: 956-750-3414
Mailing address:
  • Phone: 956-774-6020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GLORIA A SOLIS
Title or Position: MANAGER
Credential:
Phone: 956-774-6020