Healthcare Provider Details

I. General information

NPI: 1821470253
Provider Name (Legal Business Name): JENNA ZOGHBY RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2015
Last Update Date: 06/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 N BAYOU ST
MOBILE AL
36603-5827
US

IV. Provider business mailing address

251 N BAYOU ST
MOBILE AL
36603-5827
US

V. Phone/Fax

Practice location:
  • Phone: 251-690-8158
  • Fax: 251-544-2188
Mailing address:
  • Phone: 251-690-8158
  • Fax: 251-544-2188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86016642
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: