MEDICARE: DR. JOCETT ZABALA VILLANUEVA D. M. D.

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	122300000X	Dentist	39910	CA

General Provider Information

NPI Number	:	1871636308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOCETT ZABALA VILLANUEVA D. M. D.

Provider Business Mailing Address
First Line	:	3113 CLAYTON RD
Second Line	:
City	:	CONCORD
State	:	CA
Zip	:	94519-2732
Country	:	US
Telephone Number	:	925-687-9588
Fax Number	:	925-680-2583

Provider Business Practice Location Address
First Line	:	3113 CLAYTON RD
Second Line	:
City	:	CONCORD
State	:	CA
Zip	:	94519-2732
Country	:	US
Telephone Number	:	925-687-9588
Fax Number	:	925-680-2583

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

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	07/08/2007

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