Provider Demographics
NPI:1760450399
Name:DENNIS-ZARATE, KATHLEEN J (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:J
Last Name:DENNIS-ZARATE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:J
Other - Last Name:DENNIS-ZARATE A MEDICAL CORP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:222 W EULALIA ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2849
Mailing Address - Country:US
Mailing Address - Phone:818-551-7127
Mailing Address - Fax:818-551-7131
Practice Address - Street 1:222 W EULALIA ST
Practice Address - Street 2:SUITE110
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2849
Practice Address - Country:US
Practice Address - Phone:818-551-7127
Practice Address - Fax:818-551-7131
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81715207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0095000Medicaid
CA1760450399Medicaid
CAW16156OtherMEDICARE
CAG08423Medicare UPIN
CAW16156OtherMEDICARE
CAGR0095000Medicaid