Provider Demographics
NPI:1043947005
Name:ZUBERI MEDICAL GROUP INC
Entity type:Organization
Organization Name:ZUBERI MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ILLESCAS
Authorized Official - Suffix:
Authorized Official - Credentials:SURGICAL TECH
Authorized Official - Phone:310-908-9338
Mailing Address - Street 1:5200 CLARK AVE
Mailing Address - Street 2:PO BOX 532
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90714-9998
Mailing Address - Country:US
Mailing Address - Phone:310-908-9338
Mailing Address - Fax:562-808-2145
Practice Address - Street 1:3514 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712
Practice Address - Country:US
Practice Address - Phone:310-908-9338
Practice Address - Fax:562-808-2145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty