Healthcare Provider Details

I. General information

NPI: 1043068612
Provider Name (Legal Business Name): EMILY BAHAREH ZAGHI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2024
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 LAS POSAS RD STE 4
CAMARILLO CA
93010-1502
US

IV. Provider business mailing address

1203 FLYNN RD UNIT 160
CAMARILLO CA
93012-6203
US

V. Phone/Fax

Practice location:
  • Phone: 805-585-5166
  • Fax: 805-383-1786
Mailing address:
  • Phone: 805-804-4168
  • Fax: 805-830-1177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number68573
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: