Provider Demographics
NPI:1265281455
Name:ZAPATA FONSECA, JAIRO
Entity type:Individual
Prefix:
First Name:JAIRO
Middle Name:
Last Name:ZAPATA FONSECA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8314 BROADLEAF AVE
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-5532
Mailing Address - Country:US
Mailing Address - Phone:281-461-3168
Mailing Address - Fax:
Practice Address - Street 1:8314 BROADLEAF AVE
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-5532
Practice Address - Country:US
Practice Address - Phone:281-461-3168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-18
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-24-348206106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician