MEDICARE: MOISES R ZEPEDA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	A62532	CA

General Provider Information

NPI Number	:	1790779312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOISES R ZEPEDA M.D.

Provider Business Mailing Address
First Line	:	5240 E BEVERLY BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-2002
Country	:	US
Telephone Number	:	626-284-2881
Fax Number	:	626-284-2882

Provider Business Practice Location Address
First Line	:	5240 E BEVERLY BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-2002
Country	:	US
Telephone Number	:	626-284-2881
Fax Number	:	626-284-2882

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	04/05/2012

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