Basic Information
| Provider Information | |||||||||
| NPI: | 1891873329 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZEBRACK | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40285 WINCHESTER RD STE 103 | ||||||||
| Address2: | |||||||||
| City: | TEMECULA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925915547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9512965844 | ||||||||
| FaxNumber: | 9512965840 | ||||||||
| Practice Location | |||||||||
| Address1: | 40285 WINCHESTER RD STE 103 | ||||||||
| Address2: | |||||||||
| City: | TEMECULA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925915547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9512965844 | ||||||||
| FaxNumber: | 9512965840 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 05/21/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 20A5930 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00AX59300 | 05 | CA | MEDICAID |