Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | G35993 | CA |
NPI | 1154409860 |
---|---|
Provider Name | Mark J. Zlotlow |
First Address | Oakland, CA 94612-3429 |
Second Address | Roseville, CA 95661-3027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |