Healthcare Provider Details

I. General information

NPI: 1164940086
Provider Name (Legal Business Name): LARRY STEVEN ZINN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2017
Last Update Date: 08/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5625 LAKE MURRAY BLVD UNIT B
LA MESA CA
91942-1924
US

IV. Provider business mailing address

5625 LAKE MURRAY BLVD UNIT B
LA MESA CA
91942-1924
US

V. Phone/Fax

Practice location:
  • Phone: 619-464-3457
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberG17343
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: