Provider Demographics
NPI:1447278072
Name:ZIEGENBEIN, JAMES R (MD A PROF CORP)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:ZIEGENBEIN
Suffix:
Gender:M
Credentials:MD A PROF CORP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 90125
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90809-0125
Mailing Address - Country:US
Mailing Address - Phone:562-598-8558
Mailing Address - Fax:562-795-0676
Practice Address - Street 1:8301 FLORENCE AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-3948
Practice Address - Country:US
Practice Address - Phone:562-862-0604
Practice Address - Fax:562-795-0676
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68469207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G684690Medicaid
CAF12141Medicare UPIN
CAG68469BMedicare ID - Type Unspecified