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General NPI Number Information
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NPI Number | 1336134220
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Entity Type | Individual
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Provider Name | JUAN CARLOS ZARATE MD
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Gender | Male
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Dates
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Enumeration Date | 09/16/2005
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Last Update Date | 11/29/2016
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Provider Practice Location Address
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Address Line | 129 E REDSTONE AVE SUITE A
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City | CRESTVIEW
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State | FL
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Zip | 32539-5364
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Country | US
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Telephone | 850-682-7212
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Fax | 850-682-6727
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Provider Business Mailing Address
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Address Line | 129 E REDSTONE AVE SUITE A
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City | CRESTVIEW
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State | FL
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Zip | 32539-5364
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Country | US
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Telephone | 850-682-7212
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Fax | 850-682-6727
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | ME0055146
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | ME55146
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License Number State | FL
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