Healthcare Provider Details

I. General information

NPI: 1831611532
Provider Name (Legal Business Name): MEERNA HANNA ZAGHLOUL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25039 MOUND ST
LOMA LINDA CA
92354-2770
US

IV. Provider business mailing address

25039 MOUND ST
LOMA LINDA CA
92354-2770
US

V. Phone/Fax

Practice location:
  • Phone: 832-812-0911
  • Fax:
Mailing address:
  • Phone: 832-812-0911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number33127
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: