Provider Demographics
NPI:1578829156
Name:ZAPATA, CARLY SUZANNE
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:SUZANNE
Last Name:ZAPATA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:SUZANNE
Other - Last Name:BENNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1215 11TH AVE
Mailing Address - Street 2:APT 6
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-2256
Mailing Address - Country:US
Mailing Address - Phone:209-406-5942
Mailing Address - Fax:
Practice Address - Street 1:1215 11TH AVE
Practice Address - Street 2:APT 6
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-2256
Practice Address - Country:US
Practice Address - Phone:209-406-5942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-08
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA127573207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine