Provider Demographics
NPI:1164520680
Name:ZARAGOZA, MARCOS JUAN (DO)
Entity Type:Individual
Prefix:DR
First Name:MARCOS
Middle Name:JUAN
Last Name:ZARAGOZA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4780 SW 64TH AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-4400
Mailing Address - Country:US
Mailing Address - Phone:954-434-1705
Mailing Address - Fax:954-399-9987
Practice Address - Street 1:1437 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:DANIA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33004-4348
Practice Address - Country:US
Practice Address - Phone:954-399-9941
Practice Address - Fax:954-399-9987
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7334207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256539101Medicaid
FL56723ROtherMEDICARE
FLG68477Medicare UPIN