Healthcare Provider Details

I. General information

NPI: 1366547291
Provider Name (Legal Business Name): DR. KRISTINE ZMAJ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 BENTON ST
LOMA LINDA CA
92357-1000
US

IV. Provider business mailing address

11201 BENTON ST
LOMA LINDA CA
92357-1000
US

V. Phone/Fax

Practice location:
  • Phone: 909-583-6064
  • Fax: 909-777-3291
Mailing address:
  • Phone: 909-583-6064
  • Fax: 909-777-3291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA70829
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: