MEDICARE: MR. JEREMIAH CRISOLOGO ZAPANTA

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	1710I1002X	Independent Duty Corpsman

General Provider Information

NPI Number	:	1629351929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEREMIAH CRISOLOGO ZAPANTA

Provider Business Mailing Address
First Line	:	PSC 476 BOX 190
Second Line	:
City	:	FPO
State	:	AP
Zip	:	96322-0002
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PSC 476 BOX 190
Second Line	:
City	:	FPO
State	:	AP
Zip	:	96322-0002
Country	:	US
Telephone Number	:	315-252-4517
Fax Number	:

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

Provider Enumeration Date	:	09/22/2011
Last Update Date	:	06/09/2026

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Directions to “ MR. JEREMIAH CRISOLOGO ZAPANTA ” Practice Location

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