Healthcare Provider Details

I. General information

NPI: 1538366513
Provider Name (Legal Business Name): DAVID ZIBELLO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6956 AURA AVE
RESEDA CA
91335-3721
US

IV. Provider business mailing address

6956 AURA AVE
RESEDA CA
91335-3721
US

V. Phone/Fax

Practice location:
  • Phone: 818-342-8813
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA15142
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: