Healthcare Provider Details

I. General information

NPI: 1043497860
Provider Name (Legal Business Name): HAMID TAVAKOLI ZADEH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2435 MARSHALL AVE
IMPERIAL CA
92251-9599
US

IV. Provider business mailing address

2435 MARSHALL AVE
IMPERIAL CA
92251-9599
US

V. Phone/Fax

Practice location:
  • Phone: 760-550-6327
  • Fax: 760-550-6331
Mailing address:
  • Phone: 760-550-6327
  • Fax: 760-550-6331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA101245
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: