Provider Demographics
NPI:1164493862
Name:ZAPATA, OSVALDO (CRNA)
Entity Type:Individual
Prefix:
First Name:OSVALDO
Middle Name:
Last Name:ZAPATA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 DEVONSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-2659
Mailing Address - Country:US
Mailing Address - Phone:956-725-9443
Mailing Address - Fax:956-791-5549
Practice Address - Street 1:10700 MCPHERSON AVE
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6268
Practice Address - Country:US
Practice Address - Phone:956-523-2619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX461272367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83497UOtherBCBS
TX0889941-03Medicaid
TX088994106Medicaid
TX088994104Medicaid
TX00C42FOtherBCBS-PERSONAL ID NUMBER
TX088994104Medicaid
TXTXB127835Medicare PIN
TX00C42FMedicare ID - Type UnspecifiedPERSONAL ID NUMBER