Healthcare Provider Details

I. General information

NPI: 1437149226
Provider Name (Legal Business Name): JOHN M. ZEROOGIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 S RAYMOND AVE UNIT 240
PASADENA CA
91105-3283
US

IV. Provider business mailing address

630 S RAYMOND AVE UNIT 240
PASADENA CA
91105-3283
US

V. Phone/Fax

Practice location:
  • Phone: 626-449-9920
  • Fax: 626-578-7366
Mailing address:
  • Phone: 626-449-9920
  • Fax: 626-578-7366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number033771
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number73813
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: