Healthcare Provider Details

I. General information

NPI: 1871858910
Provider Name (Legal Business Name): ZAID AL-FAHAM M.D., MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2012
Last Update Date: 11/29/2021
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 CHICAGO AVE STE J3
RIVERSIDE CA
92507-2358
US

IV. Provider business mailing address

1760 CHICAGO AVE STE J3
RIVERSIDE CA
92507-2358
US

V. Phone/Fax

Practice location:
  • Phone: 951-781-2200
  • Fax:
Mailing address:
  • Phone: 951-781-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301100525
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberMD60818570
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberA168815
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: