Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | G58746 | CA |
NPI | 1013086339 |
---|---|
Provider Name | Ileana E Zapatero |
First Address | Pacific Palisades, CA 90272-3545 |
Second Address | Pacific Palisades, CA 90272-3545 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G587460 | BLUE SHIELD (01) | CA |
E23419 | (02) |