Healthcare Provider Details

I. General information

NPI: 1548783855
Provider Name (Legal Business Name): ALEX ZUTNER PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2017
Last Update Date: 07/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38600 MEDICAL CENTER DR
PALMDALE CA
93551-4483
US

IV. Provider business mailing address

3635 WAWONA ST
SAN FRANCISCO CA
94116-2632
US

V. Phone/Fax

Practice location:
  • Phone: 661-382-5000
  • Fax:
Mailing address:
  • Phone: 415-640-6344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number10961
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: