Provider Demographics
NPI:1407218936
Name:ZEPEDA, JOSE A (FNP)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:A
Last Name:ZEPEDA
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1266 PEPPER DR
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-4302
Mailing Address - Country:US
Mailing Address - Phone:760-353-6363
Mailing Address - Fax:760-353-0630
Practice Address - Street 1:1266 PEPPER DR
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4302
Practice Address - Country:US
Practice Address - Phone:760-562-6872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003783173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine