Healthcare Provider Details

I. General information

NPI: 1639590326
Provider Name (Legal Business Name): CATHERINE ZENDEJAS MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHERINE ZENDEJAS PNP-PC

II. Dates (important events)

Enumeration Date: 12/23/2013
Last Update Date: 03/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 DOC STONE RD
STAFFORD VA
22556-4515
US

IV. Provider business mailing address

164 SHORT BRANCH RD
STAFFORD VA
22556-4642
US

V. Phone/Fax

Practice location:
  • Phone: 619-300-6200
  • Fax:
Mailing address:
  • Phone: 619-300-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024177372
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number790854
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: