Healthcare Provider Details

I. General information

NPI: 1902853633
Provider Name (Legal Business Name): CRAIG L ZIERING D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2071 SAN JOAQUIN HILLS RD
NEWPORT BEACH CA
92660-6505
US

IV. Provider business mailing address

2071 SAN JOAQUIN HILLS RD
NEWPORT BEACH CA
92660-6505
US

V. Phone/Fax

Practice location:
  • Phone: 949-719-6939
  • Fax:
Mailing address:
  • Phone: 949-719-6939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number206660
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: