MEDICARE: LUZ M ZAVALA-SALCEDO PA-C

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	363AM0700X	Medical Physician Assistant	15550	CA

General Provider Information

NPI Number	:	1609939412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUZ M ZAVALA-SALCEDO PA-C

Provider Business Mailing Address
First Line	:	5850 S MAIN ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90003-1215
Country	:	US
Telephone Number	:	323-846-4087
Fax Number	:	323-232-5995

Provider Business Practice Location Address
First Line	:	5850 S MANI ST.
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90003
Country	:	US
Telephone Number	:	323-846-4087
Fax Number	:	323-232-5995

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

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	04/23/2015

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