=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952610552
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ZAPATA WOMEN'S HEALTH CENTER, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2010
-----------------------------------------------------
Last Update Date | 08/29/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4221 RIDGECREST RD #103
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75402-6017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-454-2130
-----------------------------------------------------
Fax | 903-454-5487
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 8115
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75404-8115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-454-2130
-----------------------------------------------------
Fax | 903-454-5487
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MALISSIA DENISE ZAPATA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 903-454-2130
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | L9970
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------