Provider Demographics
NPI:1235879313
Name:ZAPATA, AMANDA MONET (PA-CO)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MONET
Last Name:ZAPATA
Suffix:
Gender:F
Credentials:PA-CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 E WALNUT ST APT 206
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-3827
Mailing Address - Country:US
Mailing Address - Phone:650-515-6264
Mailing Address - Fax:
Practice Address - Street 1:1975 VERDUGO BLVD STE A
Practice Address - Street 2:
Practice Address - City:LA CANADA FLINTRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91011-3024
Practice Address - Country:US
Practice Address - Phone:818-249-9455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant