Basic Information
Provider Information
NPI: 1184613655
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ZALUDEK
FirstName: TIMOTHY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3156 VISTA WAY
Address2: SUITE 405
City: OCEANSIDE
State: CA
PostalCode: 920563622
CountryCode: US
TelephoneNumber: 7604396581
FaxNumber: 7604396585
Practice Location
Address1: 25500 MEDICAL CENTER DR
Address2:  
City: MURRIETA
State: CA
PostalCode: 925625965
CountryCode: US
TelephoneNumber: 9096966000
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/18/2005
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
174400000XG86139CAY Other Service ProvidersSpecialist 

No ID Information.


Home