Provider Demographics
NPI:1396874038
Name:ZAITLEN, NAN T (MD)
Entity type:Individual
Prefix:DR
First Name:NAN
Middle Name:T
Last Name:ZAITLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5353 BALBOA BLVD
Mailing Address - Street 2:#200
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-2804
Mailing Address - Country:US
Mailing Address - Phone:818-461-9690
Mailing Address - Fax:818-461-9482
Practice Address - Street 1:5353 BALBOA BLVD
Practice Address - Street 2:#200
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-2804
Practice Address - Country:US
Practice Address - Phone:818-461-9690
Practice Address - Fax:818-461-9482
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30827208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics