Provider Demographics
NPI:1578574943
Name:VINZON, DAISY (MD)
Entity Type:Individual
Prefix:
First Name:DAISY
Middle Name:
Last Name:VINZON
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 1:5767 W CENTURY BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5632
Mailing Address - Country:US
Mailing Address - Phone:310-546-4599
Mailing Address - Fax:310-796-4941
Practice Address - Street 1:200 MEDICAL PLAZA
Practice Address - Street 2:#265
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90074
Practice Address - Country:US
Practice Address - Phone:310-206-6923
Practice Address - Fax:310-796-4941
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73285208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G732850Medicaid
CAWG73285AMedicare PIN
CAF57696Medicare UPIN