Provider Demographics
NPI:1134497084
Name:ZARATE, MA MAGDALENA
Entity Type:Individual
Prefix:
First Name:MA
Middle Name:MAGDALENA
Last Name:ZARATE
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 1:1400 S CAGE BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-6290
Mailing Address - Country:US
Mailing Address - Phone:956-223-4239
Mailing Address - Fax:956-517-1358
Practice Address - Street 1:1400 S CAGE BLVD STE 5
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-6290
Practice Address - Country:US
Practice Address - Phone:956-223-4239
Practice Address - Fax:956-517-1358
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT04785133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered