Healthcare Provider Details

I. General information

NPI: 1417709171
Provider Name (Legal Business Name): AHMAD BELAL AL-ZUGHOUL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2024
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 N WOLFE AVE
EDWARDS CA
93524-6201
US

IV. Provider business mailing address

276 5TH AVE
REDWOOD CITY CA
94063-3734
US

V. Phone/Fax

Practice location:
  • Phone: 661-277-2145
  • Fax:
Mailing address:
  • Phone: 650-521-6489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number0101287170
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: