Provider Demographics
NPI:1194810697
Name:ZASLOW, TRACY LYNN (MD)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:ZASLOW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5353 BALBOA BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-2804
Mailing Address - Country:US
Mailing Address - Phone:818-501-7276
Mailing Address - Fax:818-501-7288
Practice Address - Street 1:2020 SANTA MONICA BLVD STE 400
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2139
Practice Address - Country:US
Practice Address - Phone:310-829-2663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80301174400000X, 208000000X, 2080S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080S0010XAllopathic & Osteopathic PhysiciansPediatricsSports Medicine
No174400000XOther Service ProvidersSpecialist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A803010Medicaid
CA00A803010Medicaid
CAWA80301AMedicare ID - Type Unspecified