MEDICARE: LESLIE ZIONTZ

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	183500000X	Pharmacist	48187	CA

General Provider Information

NPI Number	:	1275157919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE ZIONTZ

Provider Business Mailing Address
First Line	:	212 ALTA AVE
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90402-2728
Country	:	US
Telephone Number	:	310-600-5017
Fax Number	:

Provider Business Practice Location Address
First Line	:	5733 LAS VIRGENES RD STE A
Second Line	:
City	:	CALABASAS
State	:	CA
Zip	:	91302-1267
Country	:	US
Telephone Number	:	818-456-4274
Fax Number	:	818-456-4273

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

Provider Enumeration Date	:	05/28/2020
Last Update Date	:	05/28/2020

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