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General NPI Number Information
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NPI Number | 1174605612
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Entity Type | Organization
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Legal Business Name | GUSTAVO A ALZA MD A MEDICAL CORPORATION
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 02/27/2015
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Provider Practice Location Address
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Address Line | 5224 N FIGUEROA STREET
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City | LOS ANGELES
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State | CA
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Zip | 90042-4118
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Country | US
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Telephone | 323-259-0456
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Fax | 323-259-8486
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Provider Business Mailing Address
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Address Line | 5224 N FIGUEROA STREET
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City | LOS ANGELES
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State | CA
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Zip | 90042-4118
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Country | US
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Telephone | 323-259-0456
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Fax | 323-259-8486
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Authorized Official
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Title or Position | CORPORATE PRESIDENT
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Name | MR. GUSTAVO ALBERTO ALZA SR.
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Credential | MD
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Telephone | 323-259-0456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G48749
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License Number State | CA
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