Healthcare Provider Details

I. General information

NPI: 1194049965
Provider Name (Legal Business Name): MAURICE HENRY ZISSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2010
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10666 N TORREY PINES RD # 100C
LA JOLLA CA
92037-1027
US

IV. Provider business mailing address

10666 N TORREY PINES RD # 100C
LA JOLLA CA
92037-1027
US

V. Phone/Fax

Practice location:
  • Phone: 858-554-2626
  • Fax:
Mailing address:
  • Phone: 858-554-2626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number253520
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA137179
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: