Individual
TATIANA M. ZEBALLOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1408 VIA ARCO, PALOS VERDES ESTATES, CA 90274-2055
(202) 285-4550
Mailing address
1408 VIA ARCO, PALOS VERDES ESTATES, CA 90274-2055
(202) 285-4550
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
MD425510
PA
208000000X
Pediatrics Physician
ME127937
FL
2080B0002X
Pediatric Obesity Medicine Physician
Primary
C164447
CA
2083B0002X
Obesity Medicine (Preventive Medicine) Physician
C164447
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019048000
—
FL
01
—
25MA10057100
MEDICAL LICENSE
NJ
01
—
78664
MEDICAL LICENSE
GA
01
—
C1-0011945
MEDICAL LICENSE
DE
01
—
C164447
MEDICAL LICENSE
CA
01
—
D0083136
MEDICAL LICENSE
MD
01
—
MD425510
LICENSE
PA
Enumeration date
01/09/2006
Last updated
07/16/2023
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