Healthcare Provider Details

I. General information

NPI: 1871943761
Provider Name (Legal Business Name): ZUMAYA MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 W TEMPLE ST STE 1059
LOS ANGELES CA
90026-7329
US

IV. Provider business mailing address

1711 W TEMPLE ST STE 1059
LOS ANGELES CA
90026-7329
US

V. Phone/Fax

Practice location:
  • Phone: 626-899-4573
  • Fax: 626-899-4575
Mailing address:
  • Phone: 626-899-4573
  • Fax: 626-899-4575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. VICKI P ROLLINS
Title or Position: VICE-PRESIDENT
Credential: RN
Phone: 626-899-4573