MEDICARE: LARA R ZACCA DPM PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1326453309	OTHER	TX	COMMERCIALINSURANCE

General Provider Information

NPI Number	:	1467170241
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LARA R ZACCA DPM PLLC

Provider Business Mailing Address
First Line	:	6550 FANNIN ST STE 2427
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2748
Country	:	US
Telephone Number	:	832-810-4820
Fax Number	:

Provider Business Practice Location Address
First Line	:	6550 FANNIN ST STE 2427
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2748
Country	:	US
Telephone Number	:	832-573-2587
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER
Name	:	LARA R ZACCA
Credential	:	DPM
Telephone Number	:	254-739-5744

Provider Enumeration Date	:	08/18/2022
Last Update Date	:	08/16/2023

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