Provider Demographics
NPI:1942441993
Name:ZEPEDA, EDDIE (CPO)
Entity Type:Individual
Prefix:
First Name:EDDIE
Middle Name:
Last Name:ZEPEDA
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 S. DON ROSER DR
Mailing Address - Street 2:SUITE #E2
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4576
Mailing Address - Country:US
Mailing Address - Phone:915-383-8872
Mailing Address - Fax:575-993-5327
Practice Address - Street 1:1401 S. DON ROSER DR
Practice Address - Street 2:SUITE #E2
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4576
Practice Address - Country:US
Practice Address - Phone:915-383-8872
Practice Address - Fax:575-993-5327
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM09176071Medicaid
NM09176071Medicaid