Provider Demographics
NPI:1285761809
Name:ZARATE MEDICAL GROUP PA
Entity type:Organization
Organization Name:ZARATE MEDICAL GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUDOLFO
Authorized Official - Middle Name:P
Authorized Official - Last Name:ZARATE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:210-587-8787
Mailing Address - Street 1:24014 GRAN PALACIO
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78261-2766
Mailing Address - Country:US
Mailing Address - Phone:210-587-8787
Mailing Address - Fax:210-388-0239
Practice Address - Street 1:1200 BROOKLYN AVE STE 310
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4810
Practice Address - Country:US
Practice Address - Phone:210-587-8787
Practice Address - Fax:210-388-0239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1415207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179126101Medicaid
TX00W262OtherMEDICARE PTAN