Basic Information
| Provider Information | |||||||||
| NPI: | 1932286713 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZAGATA | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | LAWRENCE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 190 | ||||||||
| Address2: | |||||||||
| City: | MANZANITA | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971300190 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033686812 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2111 EXCHANGE ST | ||||||||
| Address2: | |||||||||
| City: | ASTORIA | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971033329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033254321 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 09/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 146D00000X | MD10095 | OR | Y | Emergency Medical Service Providers | Personal Emergency Response Attendant |
ID Information
| ID | Type | State | Issuer | Description | MD10095 | 01 | OR | OREGON STATE LICENSE | OTHER | 242404 | 05 | OR | MEDICAID | 1039544 | 05 | WA | MEDICAID | R0000ZBBRX | 01 | OR | BLUE CROSS | OTHER |