Healthcare Provider Details

I. General information

NPI: 1811076342
Provider Name (Legal Business Name): KATHLEEN J DENNIS-ZARATE MD A MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 01/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W EULALIA ST SUITE 110
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: MRS. JENNY RAMIREZ
Title or Position: OFFICE MANAGER
Credential: M.D.
Phone: 818-551-7127