Provider Demographics
NPI:1285676312
Name:ZANETOS, THOMAS N (DO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:N
Last Name:ZANETOS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:THOMAS
Other - Middle Name:N
Other - Last Name:ZANETOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:25900 N HIGHWAY 99
Mailing Address - Street 2:
Mailing Address - City:ACAMPO
Mailing Address - State:CA
Mailing Address - Zip Code:95220-9392
Mailing Address - Country:US
Mailing Address - Phone:209-339-9022
Mailing Address - Fax:209-339-9033
Practice Address - Street 1:911 SUNSET DR
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-5602
Practice Address - Country:US
Practice Address - Phone:831-637-5711
Practice Address - Fax:831-636-2685
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5351174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX53510Medicaid
CAC03581Medicare UPIN
CA00AX53510Medicaid