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General NPI Number Information
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NPI Number | 1326566035
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Entity Type | Organization
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Legal Business Name | CONSUELA ZAU DENTAL, INC
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Dates
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Enumeration Date | 09/01/2017
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Last Update Date | 08/06/2019
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Provider Practice Location Address
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Address Line | 4354 FOUNTAIN AVE
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City | LOS ANGELES
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State | CA
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Zip | 90029-2226
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Country | US
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Telephone | 323-741-0556
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Fax |
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Provider Business Mailing Address
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Address Line | 14500 SHERMAN CIR
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City | VAN NUYS
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State | CA
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Zip | 91405-6209
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Country | US
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Telephone | 818-259-7033
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. ELENA CONSUELA ZAU
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Credential | DDS
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Telephone | 323-741-0556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 64189
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License Number State | CA
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