1356674048 NPI number — MR. CODY LEE ZEPEDA DC, AGACNP

Table of content: MR. CODY LEE ZEPEDA DC, AGACNP (NPI 1356674048)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356674048 NPI number — MR. CODY LEE ZEPEDA DC, AGACNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZEPEDA
Provider First Name:
CODY
Provider Middle Name:
LEE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
DC, AGACNP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZEPEDA
Provider Other First Name:
CODY
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DC, AGACNP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1356674048
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
432 CIRCLEVIEW DR S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HURST
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76054-3525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-236-9635
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
432 CIRCLEVIEW DR S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HURST
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76054-3525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-236-9635
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/11/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  11233 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: AP143328 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2100X , with the licence number: AP143328 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)