1679689822 NPI number — JAMES P ZALEZ MD

Table of content: JAMES P ZALEZ MD (NPI 1679689822)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679689822 NPI number — JAMES P ZALEZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZALEZ
Provider First Name:
JAMES
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679689822
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6029 BRISTOL PKWY
Provider Second Line Business Mailing Address:
100
Provider Business Mailing Address City Name:
CULVER CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90230-6643
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-417-5900
Provider Business Mailing Address Fax Number:
310-410-1001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 SANTA MONICA BLVD
Provider Second Line Business Practice Location Address:
SUITE 860
Provider Business Practice Location Address City Name:
SANTA MONICA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90404-2102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-828-3209
Provider Business Practice Location Address Fax Number:
310-828-5165
Provider Enumeration Date:
08/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X , with the licence number:  G65652 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: WG65652C . This is a "MEDICARE LOCATION PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: W21068 . This is a "MEDICARE LOCATION PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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