MEDICARE: DR. MANUEL ZEVALLOS 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	174400000X	Specialist	A35871	CA
2	207RH0003X	Hematology & Oncology Physician	A35871	CA

General Provider Information

NPI Number	:	1174611750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANUEL ZEVALLOS MD

Provider Business Mailing Address
First Line	:	18000 STUDEBAKER RD STE 800
Second Line	:
City	:	CERRITOS
State	:	CA
Zip	:	90703-2671
Country	:	US
Telephone Number	:	562-735-3226
Fax Number	:

Provider Business Practice Location Address
First Line	:	3628 E IMPERIAL HWY STE 401
Second Line	:
City	:	LYNWOOD
State	:	CA
Zip	:	90262-2646
Country	:	US
Telephone Number	:	310-667-4000
Fax Number	:	310-667-4010

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	04/22/2020

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