Healthcare Provider Details

I. General information

NPI: 1720020175
Provider Name (Legal Business Name): OSCAR ZAGALA A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 07/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 S CENTRAL AVE
GLENDALE CA
91204-2508
US

IV. Provider business mailing address

PO BOX 60790
PASADENA CA
91116-6790
US

V. Phone/Fax

Practice location:
  • Phone: 818-502-1900
  • Fax: 818-502-4738
Mailing address:
  • Phone: 626-795-6596
  • Fax: 626-795-8247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA75130
License Number StateCA

VIII. Authorized Official

Name: DR. OSCAR J ZAGALA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-348-3445