Healthcare Provider Details

I. General information

NPI: 1275449811
Provider Name (Legal Business Name): SHAYAN ZOGHI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78289 SCARLET CT
LA QUINTA CA
92253-3845
US

IV. Provider business mailing address

78289 SCARLET CT
LA QUINTA CA
92253-3845
US

V. Phone/Fax

Practice location:
  • Phone: 559-999-0901
  • Fax: 760-496-2876
Mailing address:
  • Phone: 559-999-0901
  • Fax: 760-496-2876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: SHAYAN ZOGHI
Title or Position: PRESIDENT
Credential: DO
Phone: 559-999-0901