Healthcare Provider Details

I. General information

NPI: 1710197140
Provider Name (Legal Business Name): JAMES P ZALEZ, MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 01/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 SANTA MONICA BLVD STE 860
SANTA MONICA CA
90404-2189
US

IV. Provider business mailing address

6029 BRISTOL PKWY STE 100
CULVER CITY CA
90230-4899
US

V. Phone/Fax

Practice location:
  • Phone: 310-828-3209
  • Fax: 310-828-5165
Mailing address:
  • Phone: 310-417-4900
  • Fax: 310-410-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberG65652
License Number StateCA

VIII. Authorized Official

Name: JAMES P ZALEZ
Title or Position: OWNER
Credential: MD
Phone: 310-828-3209