Healthcare Provider Details

I. General information

NPI: 1710731369
Provider Name (Legal Business Name): ZUMAYA MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2024
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 W TEMPLE ST STE 1005
LOS ANGELES CA
90026-7329
US

IV. Provider business mailing address

1711 W TEMPLE ST STE 1005
LOS ANGELES CA
90026-7329
US

V. Phone/Fax

Practice location:
  • Phone: 213-459-1697
  • Fax: 213-315-4290
Mailing address:
  • Phone: 213-459-1697
  • Fax: 213-315-4290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. VICKI P ROLLINS
Title or Position: CO-MANAGER
Credential: RN
Phone: 213-459-1697