Doctor Name: | WALLY ZARATE |
NPI Number: | 1073984688 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | NP95002988 |
Business Practice Address: | 10372 Via Cinta Ct Elk Grove, CA - 957573496 |
Business Phone Number: | 9168120800 |
Business Fax Number: | |
Mailing Address: | 10372 Via Cinta Ct, ELK GROVE |
State: | CA |
Postal Code: | 957573496 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 10/08/2015 |
NPI Last Update Date: | 10/08/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | NP95002988 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |