Healthcare Provider Details

I. General information

NPI: 1215333158
Provider Name (Legal Business Name): SHOBI ZAIDI MD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 06/11/2021
Certification Date: 06/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12523 LIMONITE AVE # 440-353
EASTVALE CA
91752-3665
US

IV. Provider business mailing address

12523 LIMONITE AVE 440-353
MIRA LOMA CA
91752-3665
US

V. Phone/Fax

Practice location:
  • Phone: 888-480-9996
  • Fax:
Mailing address:
  • Phone: 888-480-9996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHOBI ZAIDI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 888-480-9996