Healthcare Provider Details

I. General information

NPI: 1376109686
Provider Name (Legal Business Name): ALEX ZUMBERGER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 S SAN PEDRO ST
LOS ANGELES CA
90013-2102
US

IV. Provider business mailing address

522 S SAN PEDRO ST
LOS ANGELES CA
90013-2102
US

V. Phone/Fax

Practice location:
  • Phone: 213-486-4077
  • Fax:
Mailing address:
  • Phone: 213-486-4077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number108360
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: