Healthcare Provider Details

I. General information

NPI: 1538796693
Provider Name (Legal Business Name): ZAIDAL ASEEL OBAGI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 N CANON DR
BEVERLY HILLS CA
90210-5323
US

IV. Provider business mailing address

3100 N TENAYA WAY
LAS VEGAS NV
89128-0436
US

V. Phone/Fax

Practice location:
  • Phone: 310-275-3030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA198472
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: