1376973750 NPI number — JESUS ROBERTO MUNOZ-ZARATE CADC1

Table of content: JESUS ROBERTO MUNOZ-ZARATE CADC1 (NPI 1376973750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376973750 NPI number — JESUS ROBERTO MUNOZ-ZARATE CADC1

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUNOZ-ZARATE
Provider First Name:
JESUS
Provider Middle Name:
ROBERTO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CADC1
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376973750
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9370 SW GREENBURG RD
Provider Second Line Business Mailing Address:
SUITE 601
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97223-5442
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-246-5238
Provider Business Mailing Address Fax Number:
503-246-0570

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9370 SW GREENBURG RD
Provider Second Line Business Practice Location Address:
SUITE 601
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97223-5442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-246-5238
Provider Business Practice Location Address Fax Number:
503-246-0570
Provider Enumeration Date:
11/20/2013

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: 101YA0400X , with the licence number:  05- P-04 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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