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General NPI Number Information
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NPI Number | 1033082318
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Entity Type | Organization
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Legal Business Name | PRIMCARE MEDICAL CENTER INC
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Dates
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Enumeration Date | 09/24/2025
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Last Update Date | 01/15/2026
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Provider Practice Location Address
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Address Line | 11755 VICTORY BLVD STE 100B
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91606-3423
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Country | US
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Telephone | 747-203-1909
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Fax | 747-205-2063
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Provider Business Mailing Address
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Address Line | 11755 VICTORY BLVD STE 100B
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91606-3423
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Country | US
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Telephone | 747-203-1909
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Fax | 747-205-2063
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Authorized Official
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Title or Position | CEO/ OWNER
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Name | NICHOLAS DZEBOLO
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Credential | MD
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Telephone | 747-265-6308
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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