Provider Demographics
NPI:1841230646
Name:ZIVIN-TUTELA, TRACY HOPE (MD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:HOPE
Last Name:ZIVIN-TUTELA
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 1:11037 WARNER AVE STE 265
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4007
Mailing Address - Country:US
Mailing Address - Phone:732-672-1486
Mailing Address - Fax:470-313-6152
Practice Address - Street 1:11037 WARNER AVE STE 265
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4007
Practice Address - Country:US
Practice Address - Phone:732-705-7506
Practice Address - Fax:470-313-6152
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC159109207RI0200X, 207RI0200X
NJ25MA09490600207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7377696OtherAETNA
NY2X4691OtherBCBS
NY2163038OtherCIGNA
NY02643983Medicaid
NYP3566871OtherOXFORD
NYP3566871OtherOXFORD
NY2504864OtherUNITED
NY2X4561Medicare ID - Type UnspecifiedMEDICARE
NYP3566871OtherOXFORD