Healthcare Provider Details

I. General information

NPI: 1043043250
Provider Name (Legal Business Name): ZADEH ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2024
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47120 DUNE PALMS RD STE 111
LA QUINTA CA
92253-2097
US

IV. Provider business mailing address

47120 DUNE PALMS RD STE 111
LA QUINTA CA
92253-2097
US

V. Phone/Fax

Practice location:
  • Phone: 760-564-0500
  • Fax: 760-564-0100
Mailing address:
  • Phone: 760-219-0155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HOMAN ABDOLLAHZADEH
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 760-564-0500