Healthcare Provider Details

I. General information

NPI: 1013595131
Provider Name (Legal Business Name): ZOHRA JALALA DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2926 G ST STE 201
MERCED CA
95340-2112
US

IV. Provider business mailing address

1480 SCHOENHERR AVE
BOLINGBROOK IL
60490-3215
US

V. Phone/Fax

Practice location:
  • Phone: 510-825-5565
  • Fax:
Mailing address:
  • Phone: 510-825-5565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE6060
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: