Healthcare Provider Details

I. General information

NPI: 1538504733
Provider Name (Legal Business Name): SHAWN ZARDOUZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2013
Last Update Date: 07/08/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 SUPERIOR AVE STE 350
NEWPORT BEACH CA
92663-3672
US

IV. Provider business mailing address

PO BOX 1133
COSTA MESA CA
92628-1133
US

V. Phone/Fax

Practice location:
  • Phone: 949-232-1019
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA131987
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License NumberA131987
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: