Healthcare Provider Details

I. General information

NPI: 1265147011
Provider Name (Legal Business Name): MARIYA A ZAKIUDDIN, MD, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E OLIVE AVE STE 240
BURBANK CA
91501-2171
US

IV. Provider business mailing address

500 E OLIVE AVE STE 240
BURBANK CA
91501-2171
US

V. Phone/Fax

Practice location:
  • Phone: 818-391-2400
  • Fax:
Mailing address:
  • Phone: 818-391-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIYA ZAKIUDDIN
Title or Position: OWNER
Credential: MD
Phone: 630-605-0630