Provider Demographics
NPI:1891873329
Name:ZEBRACK, DAVID (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:ZEBRACK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40285 WINCHESTER RD STE 103
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-5547
Mailing Address - Country:US
Mailing Address - Phone:951-296-5844
Mailing Address - Fax:951-296-5840
Practice Address - Street 1:40285 WINCHESTER RD STE 103
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-5547
Practice Address - Country:US
Practice Address - Phone:951-296-5844
Practice Address - Fax:951-296-5840
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5930207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX59300Medicaid
CA020A59300Medicare ID - Type Unspecified
CA00AX59300Medicaid