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General NPI Number Information
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NPI Number | 1396059150
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Entity Type | Individual
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Provider Name | ANDRES GONZALO ZULETA M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/03/2010
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Last Update Date | 06/13/2019
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Provider Practice Location Address
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Address Line | 2020 CAPITOL ST NE
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City | SALEM
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State | OR
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Zip | 97301-0698
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Country | US
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Telephone | 503-399-2424
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Fax | 503-375-7429
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Provider Business Mailing Address
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Address Line | PO BOX 8100
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City | SALEM
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State | OR
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Zip | 97303-0900
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Country | US
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Telephone | 503-399-2424
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Fax | 503-375-7429
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 272646
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | L.3596R
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 053530
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD191405
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License Number State | OR
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