Provider Demographics
NPI:1679612295
Name:ZIPEROVICH, HECTOR LUIS (MD)
Entity type:Individual
Prefix:
First Name:HECTOR
Middle Name:LUIS
Last Name:ZIPEROVICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 S BEVERLY GLEN BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-2617
Mailing Address - Country:US
Mailing Address - Phone:310-864-1118
Mailing Address - Fax:310-234-2555
Practice Address - Street 1:3828 DELMAS TER
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2713
Practice Address - Country:US
Practice Address - Phone:310-836-7000
Practice Address - Fax:310-815-5036
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42139174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG42139AMedicare PIN