Healthcare Provider Details

I. General information

NPI: 1366047011
Provider Name (Legal Business Name): SAMUEL ZEMEDE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8354 SANTA MONICA BLVD
WEST HOLLYWOOD CA
90069-4313
US

IV. Provider business mailing address

5618 1/2 BAKMAN AVE
NORTH HOLLYWOOD CA
91601-1721
US

V. Phone/Fax

Practice location:
  • Phone: 323-831-2455
  • Fax:
Mailing address:
  • Phone: 559-289-0595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number299221
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: