Healthcare Provider Details

I. General information

NPI: 1629501937
Provider Name (Legal Business Name): MEGHAN ZOMORODI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 03/14/2025
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FALLS CANYON ROAD
AVALON CA
90704-2990
US

IV. Provider business mailing address

PO BOX 1563
AVALON CA
90704-2990
US

V. Phone/Fax

Practice location:
  • Phone: 310-510-0096
  • Fax: 310-510-2381
Mailing address:
  • Phone: 310-510-0096
  • Fax: 310-510-2381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number18426
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036152801
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18426
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: