Healthcare Provider Details

I. General information

NPI: 1710026067
Provider Name (Legal Business Name): Z AYYOUB MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16660 PARAMOUNT BLVD SUITE 101
PARAMOUNT CA
90723-5433
US

IV. Provider business mailing address

PO BOX 90936
CITY OF INDUSTRY CA
91715-0936
US

V. Phone/Fax

Practice location:
  • Phone: 562-633-0976
  • Fax: 562-401-6247
Mailing address:
  • Phone: 562-633-0976
  • Fax: 562-401-6247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License NumberA53397
License Number StateCA

VIII. Authorized Official

Name: ZIYAD A AYYOUB
Title or Position: OWNER PRESIDENT
Credential: M.D.
Phone: 562-633-0976