Healthcare Provider Details

I. General information

NPI: 1013991041
Provider Name (Legal Business Name): BABAK ZAMIRI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6180 BROCKTON AVE STE 204
RIVERSIDE CA
92506-2233
US

IV. Provider business mailing address

6180 BROCKTON AVE 204
RIVERSIDE CA
92506-2228
US

V. Phone/Fax

Practice location:
  • Phone: 951-781-7700
  • Fax: 951-781-0313
Mailing address:
  • Phone: 951-781-7700
  • Fax: 951-781-0313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA79726
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: