Provider Demographics
NPI:1780760603
Name:ZEGARRA, CARMEN L (MD)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:L
Last Name:ZEGARRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:LUISA
Other - Last Name:REANO GUERRERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2806 FLINTROCK TRACE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738
Mailing Address - Country:US
Mailing Address - Phone:512-584-8196
Mailing Address - Fax:512-584-8196
Practice Address - Street 1:2806 FLINTROCK TRACE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738
Practice Address - Country:US
Practice Address - Phone:512-584-8196
Practice Address - Fax:512-584-8196
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2016-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA558072084P0800X
TXM84502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5186307Medicaid
NJ5186307Medicaid
F39024Medicare UPIN