Healthcare Provider Details

I. General information

NPI: 1396448577
Provider Name (Legal Business Name): DAVID ZAMORA DIAZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 WESTWOOD PLZ
LOS ANGELES CA
90095-7419
US

IV. Provider business mailing address

757 WESTWOOD PLZ
LOS ANGELES CA
90095-7419
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-8373
  • Fax:
Mailing address:
  • Phone: 310-825-8373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.082925
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA207908
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: