Provider Demographics
NPI:1538490917
Name:ZEGARRA LOZA, RICARDO DAVID (PEDIATRICIAN)
Entity Type:Individual
Prefix:
First Name:RICARDO DAVID
Middle Name:
Last Name:ZEGARRA LOZA
Suffix:
Gender:M
Credentials:PEDIATRICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 S CAMROSE WAY
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92802-2415
Mailing Address - Country:US
Mailing Address - Phone:312-502-7263
Mailing Address - Fax:
Practice Address - Street 1:1186 LELAND AVE
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-7811
Practice Address - Country:US
Practice Address - Phone:559-686-9097
Practice Address - Fax:559-688-8756
Is Sole Proprietor?:No
Enumeration Date:2010-01-25
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 110023208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics