Provider Demographics
NPI:1609939412
Name:ZAVALA-SALCEDO, LUZ M (PA-C)
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:M
Last Name:ZAVALA-SALCEDO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5850 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90003-1215
Mailing Address - Country:US
Mailing Address - Phone:323-846-4087
Mailing Address - Fax:323-232-5995
Practice Address - Street 1:5850 S MANI ST.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90003
Practice Address - Country:US
Practice Address - Phone:323-846-4087
Practice Address - Fax:323-232-5995
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15550363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical