Healthcare Provider Details

I. General information

NPI: 1811179955
Provider Name (Legal Business Name): MICHAEL ZAGHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 10/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18436 ROSCOE BLVD
NORTHRIDGE CA
91325-4107
US

IV. Provider business mailing address

5739 WILKINSON AVE
VALLEY VILLAGE CA
91607-1631
US

V. Phone/Fax

Practice location:
  • Phone: 818-435-1400
  • Fax:
Mailing address:
  • Phone: 847-477-1189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA124820
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: