Provider Demographics
NPI:1699935940
Name:ZEBALLOS ZUNIGA, PALOMA IVONNE
Entity type:Individual
Prefix:
First Name:PALOMA
Middle Name:IVONNE
Last Name:ZEBALLOS ZUNIGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PALOMA
Other - Middle Name:YVONNE
Other - Last Name:ZEBALLOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:717 W OLYMPIC BLVD
Mailing Address - Street 2:2102
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-1497
Mailing Address - Country:US
Mailing Address - Phone:217-320-5068
Mailing Address - Fax:
Practice Address - Street 1:5425 POMONA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-1716
Practice Address - Country:US
Practice Address - Phone:323-728-0411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA126696207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine