Healthcare Provider Details

I. General information

NPI: 1861095127
Provider Name (Legal Business Name): ZOOMDOCTORSONLINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 WILSHIRE BLVD STE 220
SANTA MONICA CA
90403-4749
US

IV. Provider business mailing address

2730 WILSHIRE BLVD STE 220
SANTA MONICA CA
90403-4749
US

V. Phone/Fax

Practice location:
  • Phone: 747-400-9002
  • Fax:
Mailing address:
  • Phone: 747-400-9002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. VERONICA LAZARUS
Title or Position: CEO
Credential: MD
Phone: 747-400-9002