Healthcare Provider Details

I. General information

NPI: 1356655492
Provider Name (Legal Business Name): HAMID ZADEH MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2010
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
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: ERICA TAVAKOLI STAUF
Title or Position: OWNER
Credential:
Phone: 760-550-6327