Provider Demographics
NPI:1881710283
Name:ZEPEDA, JESSE R (PA)
Entity type:Individual
Prefix:MR
First Name:JESSE
Middle Name:R
Last Name:ZEPEDA
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:5080 SPECTRUM DR
Mailing Address - Street 2:SUITE 1200 WEST
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4648
Mailing Address - Country:US
Mailing Address - Phone:972-364-8000
Mailing Address - Fax:
Practice Address - Street 1:26 CENTERPOINTE DR
Practice Address - Street 2:SUITE 115
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1072
Practice Address - Country:US
Practice Address - Phone:615-778-4066
Practice Address - Fax:615-778-9114
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 11631363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ07334ZMedicare PIN
CACG216ZMedicare UPIN