Healthcare Provider Details

I. General information

NPI: 1760450399
Provider Name (Legal Business Name): KATHLEEN J DENNIS-ZARATE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHLEEN J DENNIS-ZARATE A MEDICAL CORP M.D.

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W EULALIA ST SUITE110
GLENDALE CA
91204-2849
US

IV. Provider business mailing address

222 W EULALIA ST SUITE 110
GLENDALE CA
91204-2849
US

V. Phone/Fax

Practice location:
  • Phone: 818-551-7127
  • Fax: 818-551-7131
Mailing address:
  • Phone: 818-551-7127
  • Fax: 818-551-7131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG81715
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: