Healthcare Provider Details

I. General information

NPI: 1063452415
Provider Name (Legal Business Name): PHILLIP G ZENTNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 05/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 MEDICAL CENTER CT
CHULA VISTA CA
91911-6617
US

IV. Provider business mailing address

PO BOX 710488
SAN DIEGO CA
92171-0488
US

V. Phone/Fax

Practice location:
  • Phone: 619-482-5851
  • Fax: 619-482-5865
Mailing address:
  • Phone: 619-326-0700
  • Fax: 619-326-0703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG83516
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberG83516
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: