Basic Information
| Provider Information | |||||||||
| NPI: | 1679689822 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZALEZ | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6029 BRISTOL PKWY | ||||||||
| Address2: | 100 | ||||||||
| City: | CULVER CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902306643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104175900 | ||||||||
| FaxNumber: | 3104101001 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 SANTA MONICA BLVD | ||||||||
| Address2: | SUITE 860 | ||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904042102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108283209 | ||||||||
| FaxNumber: | 3108285165 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 12/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | G65652 | CA | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | WG65652C | 01 | CA | MEDICARE LOCATION PTAN | OTHER | W21068 | 01 | CA | MEDICARE LOCATION PTAN | OTHER |