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General NPI Number Information
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NPI Number | 1316049463
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Entity Type | Organization
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Legal Business Name | GARY L ZAGELBAUM, MD A PROF CORP
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 03/19/2013
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Provider Practice Location Address
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Address Line | 6200 WILSHIRE BLVD SUITE 1504
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City | LOS ANGELES
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State | CA
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Zip | 90048-5816
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Country | US
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Telephone | 323-857-1323
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Fax | 323-857-7089
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Provider Business Mailing Address
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Address Line | 6200 WILSHIRE BLVD SUITE 1504
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City | LOS ANGELES
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State | CA
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Zip | 90048-5816
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Country | US
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Telephone | 323-857-1323
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Fax | 323-857-7089
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Authorized Official
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Title or Position | PRESIDENT PHYSICIAN
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Name | DR. GARY L ZAGELBAUM
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Credential | MD
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Telephone | 323-857-1323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | G36630
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License Number State | CA
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