Active NPI
Ileana E Zapatero, MD
- Dermatology Physician
- Pacific Palisades, CA
National Provider Identifier
1013086339
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- G58746
- Practice address
- 910 Via de la Paz
Suite 205
Pacific Palisades, CA 90272-3545 - Phone
- (310) 454-5555
- Fax
- (310) 454-0492
- NPI assigned
- Nov 8, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | G58746 | CA | Primary |
Addresses
Primary practice location
910 Via de la Paz
Suite 205
Pacific Palisades, CA 90272-3545
Mailing address
910 Via de la Paz
Suite 205
Pacific Palisades, CA 90272-3545
Phone (310) 454-5555
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G587460 | Other | CA | BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2021 through Jan 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G58746 | CA | MD | Dermatology Physician |
Interoperability endpoints
- https://api.platform.athenahealth.com/15234/brand/1/csg/1/fhir/r4
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013086339",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "910 VIA DE LA PAZ",
"address_2": "SUITE 205",
"city": "PACIFIC PALISADES",
"state": "CA",
"postal_code": "902723545",
"telephone_number": "310-454-5555",
"fax_number": "310-454-0492"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "910 VIA DE LA PAZ",
"address_2": "SUITE 205",
"city": "PACIFIC PALISADES",
"state": "CA",
"postal_code": "902723545",
"telephone_number": "310-454-5555",
"fax_number": "310-454-0492"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZAPATERO",
"first_name": "ILEANA",
"middle_name": "E",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "CA",
"license": "G58746",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "00G587460",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pacific Palisades, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.