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General NPI Number Information
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NPI Number | 1609339258
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Entity Type | Organization
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Legal Business Name | TRACY ZIVIN-TUTELA MD
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Dates
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Enumeration Date | 04/10/2019
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Last Update Date | 12/06/2021
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Provider Practice Location Address
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Address Line | 11037 WARNER AVE STE 265
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-4007
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Country | US
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Telephone | 732-672-1486
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Fax | 470-313-6152
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Provider Business Mailing Address
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Address Line | 11037 WARNER AVE STE 265
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-4007
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Country | US
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Telephone | 732-672-1486
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Fax | 470-313-6152
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Authorized Official
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Title or Position | PRESIDENT
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Name | TRACY ZIVIN-TUTELA
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Credential | MD
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Telephone | 732-672-1486
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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