Dzebolo MD Group Inc

Primary specialty

SpecialistTaxonomy code 174400000X

License

6036396 Issued in CA

Legal business name

DZEBOLO MD GROUP INC

Practice address

2105 Beverly Blvd Ste 111
Los Angeles, CA 90057-2252

Phone

(213) 484-3994

Fax

(213) 484-8795

NPI assigned

Nov 13, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nicholas N Dzebolo, MD

Title

Owner

Phone

(213) 484-3994

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1447372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447632000000",
    "number": "1023482007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 RIDGESIDE DR",
            "city": "MONTEREY PARK",
            "state": "CA",
            "postal_code": "917543731",
            "telephone_number": "626-281-6442",
            "fax_number": "888-302-2447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2105 BEVERLY BLVD STE 111",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900572252",
            "telephone_number": "213-484-3994",
            "fax_number": "213-484-8795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DZEBOLO MD GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-13",
        "last_updated": "2015-11-16",
        "status": "A",
        "authorized_official_last_name": "DZEBOLO",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "213-484-3994",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "6036396",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.