Provider Demographics
NPI:1427054055
Name:ZARATE, JOCELYN VILLANUEVA (MD)
Entity type:Individual
Prefix:DR
First Name:JOCELYN
Middle Name:VILLANUEVA
Last Name:ZARATE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JOCELYN
Other - Middle Name:HIROKO
Other - Last Name:VILLANUEVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
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
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3123207R00000X
OH35-07-9365207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1791261-01Medicaid
OH2288019Medicaid
OHZA 4061061Medicare ID - Type UnspecifiedINDIVIDUAL
OH2288019Medicaid
TX8F2534Medicare ID - Type Unspecified