Provider Demographics
NPI:1699816421
Name:TUJUNGA MEDICAL GROUP
Entity Type:Organization
Organization Name:TUJUNGA MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAREK
Authorized Official - Middle Name:K
Authorized Official - Last Name:ZDARZYL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-353-8581
Mailing Address - Street 1:6673 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91042-2706
Mailing Address - Country:US
Mailing Address - Phone:818-353-8581
Mailing Address - Fax:818-353-0434
Practice Address - Street 1:6673 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:TUJUNGA
Practice Address - State:CA
Practice Address - Zip Code:91042-2706
Practice Address - Country:US
Practice Address - Phone:818-353-8581
Practice Address - Fax:818-353-0434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48707207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF57083Medicare UPIN
CAG44201Medicare UPIN
CAW13760Medicare ID - Type UnspecifiedTUJUNGA MEDICAL GROUP
CAF42864Medicare UPIN