Provider Demographics
NPI:1336767771
Name:CONSULTORIO MEDICO DR VICTOR A ZAPATA LLC
Entity Type:Organization
Organization Name:CONSULTORIO MEDICO DR VICTOR A ZAPATA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ZAPATA GUZMAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:VICTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-740-7945
Mailing Address - Street 1:PO BOX 752
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-0752
Mailing Address - Country:US
Mailing Address - Phone:787-740-7945
Mailing Address - Fax:787-780-7430
Practice Address - Street 1:AVE TNTE NELSON MARTINEZ EDIF 500
Practice Address - Street 2:PLAZA CHEVERE LOCAL 5 ALTURAS DE FLAMBOYAN
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960
Practice Address - Country:US
Practice Address - Phone:787-740-7945
Practice Address - Fax:787-780-7430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1699782235Medicaid