Provider Demographics
NPI:1811015746
Name:CANCEL ZAPATA, EDGAR A (MD)
Entity Type:Individual
Prefix:
First Name:EDGAR
Middle Name:A
Last Name:CANCEL ZAPATA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 1624
Mailing Address - Street 2:
Mailing Address - City:SABANA HOYOS
Mailing Address - State:PR
Mailing Address - Zip Code:00688-9998
Mailing Address - Country:US
Mailing Address - Phone:787-817-0409
Mailing Address - Fax:
Practice Address - Street 1:CARR. 639 KM 4.8
Practice Address - Street 2:SECTOR LA VILLA
Practice Address - City:SABANA HOYOS
Practice Address - State:PR
Practice Address - Zip Code:00688-0176
Practice Address - Country:US
Practice Address - Phone:787-817-0409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9878208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR82269Medicare ID - Type Unspecified
PRF25920Medicare UPIN