Provider Demographics
NPI:1710057732
Name:JACINTO ZATA, JANETH CONCEPCION (MD)
Entity Type:Individual
Prefix:DR
First Name:JANETH
Middle Name:CONCEPCION
Last Name:JACINTO ZATA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JANETH
Other - Middle Name:CONCEPCION
Other - Last Name:ZATA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:2 MYRTLE LANE
Mailing Address - City:HARDIN
Mailing Address - State:IL
Mailing Address - Zip Code:62047-0310
Mailing Address - Country:US
Mailing Address - Phone:618-576-2416
Mailing Address - Fax:618-576-9298
Practice Address - Street 1:2 MYRTLE LANE
Practice Address - Street 2:
Practice Address - City:HARDIN
Practice Address - State:IL
Practice Address - Zip Code:62047-0310
Practice Address - Country:US
Practice Address - Phone:618-576-2416
Practice Address - Fax:618-576-9298
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36068286208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36068286Medicaid
IL0000715000OtherBCBS
IL0000715000OtherBCBS
ILK46263Medicare PIN