Provider Demographics
NPI:1922017748
Name:ZAPATA, MALISSIA D (MD)
Entity Type:Individual
Prefix:
First Name:MALISSIA
Middle Name:D
Last Name:ZAPATA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4221 RIDGECREST RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402-6005
Mailing Address - Country:US
Mailing Address - Phone:903-455-9582
Mailing Address - Fax:903-455-5689
Practice Address - Street 1:4221 RIDGECREST RD
Practice Address - Street 2:SUITE 109
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402-6005
Practice Address - Country:US
Practice Address - Phone:903-455-9582
Practice Address - Fax:903-455-5689
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9970207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX752941533OtherTAX IDENTIFICATION NUMBER
TX752941533OtherTAX IDENTIFICATION NUMBER