Provider Demographics
NPI:1801992102
Name:ZELTZER, LONNIE KAYE (MD)
Entity type:Individual
Prefix:DR
First Name:LONNIE
Middle Name:KAYE
Last Name:ZELTZER
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 1:10833 LE CONTE AVENUE
Mailing Address - Street 2:22-464 MDCC
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095
Mailing Address - Country:US
Mailing Address - Phone:310-825-0731
Mailing Address - Fax:310-794-2104
Practice Address - Street 1:200 MED PLAZA SUITE 265
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095
Practice Address - Country:US
Practice Address - Phone:310-825-0731
Practice Address - Fax:310-794-2104
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG21507208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0053510Medicaid
CA00G215070Medicaid
CAA90711Medicare UPIN
CAW11810Medicare ID - Type UnspecifiedGROUP
CAGR0053510Medicaid