Healthcare Provider Details

I. General information

NPI: 1548846181
Provider Name (Legal Business Name): ETHAN ANTHONY ZACCAGNINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 WESTWOOD PLZ STE 1638
LOS ANGELES CA
90095-7419
US

IV. Provider business mailing address

757 WESTWOOD PLZ STE 1638
LOS ANGELES CA
90095-7419
US

V. Phone/Fax

Practice location:
  • Phone: 310-267-8797
  • Fax: 310-267-2059
Mailing address:
  • Phone: 310-267-8797
  • Fax: 310-267-2059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA181344
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: