Healthcare Provider Details

I. General information

NPI: 1356428056
Provider Name (Legal Business Name): EILEEN B ZEGAR L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 06/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11685 MAGNOLIA BLVD
VALLEY VILLAGE CA
91601-3065
US

IV. Provider business mailing address

PO BOX 351775
LOS ANGELES CA
90035-0226
US

V. Phone/Fax

Practice location:
  • Phone: 323-497-3066
  • Fax:
Mailing address:
  • Phone: 323-896-2344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 9833
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: