Healthcare Provider Details

I. General information

NPI: 1194810697
Provider Name (Legal Business Name): TRACY LYNN ZASLOW MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/04/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 SANTA MONICA BLVD STE 400
SANTA MONICA CA
90404-2139
US

IV. Provider business mailing address

5353 BALBOA BLVD SUITE 202
ENCINO CA
91316-2804
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-2663
  • Fax:
Mailing address:
  • Phone: 818-501-7276
  • Fax: 818-501-7288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA80301
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA80301
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License NumberA80301
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: