Healthcare Provider Details

I. General information

NPI: 1083285175
Provider Name (Legal Business Name): SHAWN ZARDOUZ M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 SUPERIOR AVE STE 205
NEWPORT BEACH CA
92663-3667
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 Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHAWN ZARDOUZ
Title or Position: PRESIDENT
Credential: MD
Phone: 313-407-9530