Healthcare Provider Details

I. General information

NPI: 1477888154
Provider Name (Legal Business Name): DIANA ZAGALSKAYA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2009
Last Update Date: 10/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14111 VAN NESS AVE
GARDENA CA
90249-2950
US

IV. Provider business mailing address

1037 N VISTA ST APT 202
WEST HOLLYWOOD CA
90046-6632
US

V. Phone/Fax

Practice location:
  • Phone: 310-329-2121
  • Fax:
Mailing address:
  • Phone: 323-449-3019
  • Fax: 323-512-7863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA106875
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: