Healthcare Provider Details

I. General information

NPI: 1790142917
Provider Name (Legal Business Name): LIDIA ZARGARI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2016
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 S CENTRAL AVE STE 350
GLENDALE CA
91204-4647
US

IV. Provider business mailing address

519 E BROADWAY
GLENDALE CA
91205-1110
US

V. Phone/Fax

Practice location:
  • Phone: 818-616-7557
  • Fax:
Mailing address:
  • Phone: 818-409-3020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA53138
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: