Healthcare Provider Details

I. General information

NPI: 1659638120
Provider Name (Legal Business Name): DANIEL ZAGHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5971 VENICE BLVD
LOS ANGELES CA
90034-1713
US

IV. Provider business mailing address

5971 VENICE BLVD
LOS ANGELES CA
90034-1713
US

V. Phone/Fax

Practice location:
  • Phone: 800-954-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberAFE1090120
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: