Provider Demographics
NPI:1821029331
Name:ZARAGOZA, JOVANNELLY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOVANNELLY
Middle Name:
Last Name:ZARAGOZA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5904 WEST DR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6047
Mailing Address - Country:US
Mailing Address - Phone:956-726-9418
Mailing Address - Fax:956-726-7654
Practice Address - Street 1:5904 WEST DR STE 9
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6029
Practice Address - Country:US
Practice Address - Phone:956-726-9418
Practice Address - Fax:956-729-7654
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX22598OtherTEXAS STATE LICENSE
TX00CH47Medicare ID - Type UnspecifiedFQHC GROUP NUMBER