Healthcare Provider Details

I. General information

NPI: 1598154478
Provider Name (Legal Business Name): TAQIALDEEN ZAMIL PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2015
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 W STEWART DR STE 301
ORANGE CA
92868-3838
US

IV. Provider business mailing address

101 S BILLIE JO CIR
ANAHEIM CA
92806-3101
US

V. Phone/Fax

Practice location:
  • Phone: 714-712-0711
  • Fax: 657-224-4781
Mailing address:
  • Phone: 714-248-3764
  • Fax: 512-521-0386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number03557
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95003782
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: