1710057732 NPI number — DR. JANETH CONCEPCION JACINTO ZATA MD

Table of content: DR. JANETH CONCEPCION JACINTO ZATA MD (NPI 1710057732)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710057732 NPI number — DR. JANETH CONCEPCION JACINTO ZATA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JACINTO ZATA
Provider First Name:
JANETH
Provider Middle Name:
CONCEPCION
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZATA
Provider Other First Name:
JANETH
Provider Other Middle Name:
CONCEPCION
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1710057732
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/31/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 310
Provider Second Line Business Mailing Address:
2 MYRTLE LANE
Provider Business Mailing Address City Name:
HARDIN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62047-0310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-576-2416
Provider Business Mailing Address Fax Number:
618-576-9298

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 MYRTLE LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARDIN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62047-0310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-576-2416
Provider Business Practice Location Address Fax Number:
618-576-9298
Provider Enumeration Date:
11/08/2006

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: 208D00000X , with the licence number:  36068286 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 36068286 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000715000 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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