Provider Demographics
NPI:1538202148
Name:ZARATE, SANDRA MARIE (PTA)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:MARIE
Last Name:ZARATE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 DOGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-8057
Mailing Address - Country:US
Mailing Address - Phone:707-647-3950
Mailing Address - Fax:
Practice Address - Street 1:131 DOGWOOD LN
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-8057
Practice Address - Country:US
Practice Address - Phone:707-647-3950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT5931225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAT5931OtherLICENSE