Provider Demographics
NPI:1104377985
Name:ZAPATA, IDALIS
Entity Type:Individual
Prefix:
First Name:IDALIS
Middle Name:
Last Name:ZAPATA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 OLINVILLE AVE
Mailing Address - Street 2:APT #17D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-5534
Mailing Address - Country:US
Mailing Address - Phone:917-362-7828
Mailing Address - Fax:
Practice Address - Street 1:3555 OLINVILLE AVE
Practice Address - Street 2:APT #17D
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-5534
Practice Address - Country:US
Practice Address - Phone:917-362-7828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist