MEDICARE: TATIANA M. ZEBALLOS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	MD425510	PA
2	208000000X	Pediatrics Physician	ME127937	FL
3	2083B0002X	Obesity Medicine (Preventive Medicine) Physician	C164447	CA
4	2080B0002X	Pediatric Obesity Medicine Physician	C164447	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C164447	OTHER	CA	MEDICAL LICENSE
2	D0083136	OTHER	MD	MEDICAL LICENSE
3	25MA10057100	OTHER	NJ	MEDICAL LICENSE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	78664	OTHER	GA	MEDICAL LICENSE
6	C1-0011945	OTHER	DE	MEDICAL LICENSE
7	MD425510	OTHER	PA	LICENSE

General Provider Information

NPI Number	:	1053399162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TATIANA M. ZEBALLOS MD

Provider Business Mailing Address
First Line	:	1408 VIA ARCO
Second Line	:
City	:	PALOS VERDES ESTATES
State	:	CA
Zip	:	90274-2055
Country	:	US
Telephone Number	:	202-285-4550
Fax Number	:

Provider Business Practice Location Address
First Line	:	1408 VIA ARCO
Second Line	:
City	:	PALOS VERDES ESTATES
State	:	CA
Zip	:	90274-2055
Country	:	US
Telephone Number	:	202-285-4550
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	07/16/2023

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Directions to “ TATIANA M. ZEBALLOS MD” Practice Location

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