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General NPI Number Information
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NPI Number | 1598192387
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Entity Type | Individual
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Provider Name | BERNICE ZACNITE ESTEGHAMATDARSHAD P.A.
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Gender | Female
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Dates
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Enumeration Date | 10/11/2013
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Last Update Date | 04/30/2014
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Provider Practice Location Address
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Address Line | 6801 MCPHERSON RD STE 331
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City | LAREDO
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State | TX
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Zip | 78041-6417
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Country | US
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Telephone | 956-722-9918
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Fax | 956-722-0829
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Provider Business Mailing Address
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Address Line | P.O. BOX 450329
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City | LAREDO
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State | TX
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Zip | 78045-0329
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Country | US
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Telephone | 956-722-9918
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Fax | 956-722-0829
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA08752
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License Number State | TX
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