Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 2012-1731 | NC |
Y | 2080P0203X | Pediatric Critical Care Doctor | 2012-01731 | NC |
NPI | 1235353954 |
---|---|
Provider Name | Ms. Beatrice Guadalupe Zepeda |
First Address | Charlotte, NC 28275-1069 |
Second Address | Greenville, NC 27834-4300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2007 |
Last Update Date | 01/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1235353954 | (05) | NC |
1791F | BCBS NC (01) | NC |