Provider Demographics
NPI:1992146575
Name:ZAPATA, DOMINGO
Entity type:Individual
Prefix:MR
First Name:DOMINGO
Middle Name:
Last Name:ZAPATA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1047
Mailing Address - Country:US
Mailing Address - Phone:559-268-6480
Mailing Address - Fax:559-327-5122
Practice Address - Street 1:1414 W KEARNEY BLVD
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-2702
Practice Address - Country:US
Practice Address - Phone:559-485-0501
Practice Address - Fax:559-485-1313
Is Sole Proprietor?:No
Enumeration Date:2013-07-11
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1262101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)