Healthcare Provider Details

I. General information

NPI: 1932137544
Provider Name (Legal Business Name): TAREK ZAKI MAHDI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 ORANGE ST
RIVERSIDE CA
92501-3829
US

IV. Provider business mailing address

4310 ORANGE ST
RIVERSIDE CA
92501-3829
US

V. Phone/Fax

Practice location:
  • Phone: 951-781-6335
  • Fax: 951-208-7244
Mailing address:
  • Phone: 951-781-6335
  • Fax: 951-781-6365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA53772
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: