MEDICARE: CARLY SUZANNE ZAPATA

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	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	A127573	CA

General Provider Information

NPI Number	:	1578829156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLY SUZANNE ZAPATA

Provider Business Mailing Address
First Line	:	1215 11TH AVE
Second Line	:	APT 6
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-2256
Country	:	US
Telephone Number	:	209-406-5942
Fax Number	:

Provider Business Practice Location Address
First Line	:	1215 11TH AVE
Second Line	:	APT 6
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-2256
Country	:	US
Telephone Number	:	209-406-5942
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2012
Last Update Date	:	02/13/2018

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