Healthcare Provider Details

I. General information

NPI: 1952589533
Provider Name (Legal Business Name): LISA JUDITH ZWERLING M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 W 6TH ST
SAN PEDRO CA
90731-2521
US

IV. Provider business mailing address

593 W 6TH ST
SAN PEDRO CA
90731-2521
US

V. Phone/Fax

Practice location:
  • Phone: 310-547-0202
  • Fax: 310-547-5096
Mailing address:
  • Phone: 310-547-0202
  • Fax: 310-547-5096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA75473
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberA75473
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: