Provider Demographics
NPI:1477104958
Name:ZEPEDA, LUIS PUENTE
Entity Type:Individual
Prefix:
First Name:LUIS PUENTE
Middle Name:
Last Name:ZEPEDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 CRAWFORD DR
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-7300
Mailing Address - Country:US
Mailing Address - Phone:408-655-1744
Mailing Address - Fax:
Practice Address - Street 1:1883 SHAMROCK AVE
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-2419
Practice Address - Country:US
Practice Address - Phone:408-246-1883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide