MEDICARE: DIANA PATRICIA ZARATE RN

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	163WP0200X	Pediatric Registered Nurse	953690	TX

General Provider Information

NPI Number	:	1629553805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA PATRICIA ZARATE RN

Provider Business Mailing Address
First Line	:	809 SAN PEDRO DR APT B
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-6625
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4060 HIGHWAY 6 S STE 150
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-8962
Country	:	US
Telephone Number	:	979-431-3380
Fax Number	:

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

Provider Enumeration Date	:	10/03/2018
Last Update Date	:	10/03/2018

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