Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | A159105 | CA |
NPI | 1295266179 |
---|---|
Provider Name | Zachary Ernstberger |
First Address | Playa Vista, CA 90094-2885 |
Second Address | Playa Vista, CA 90094-2776 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2017 |
Last Update Date | 20/07/2020 |