Healthcare Provider Details

I. General information

NPI: 1609054485
Provider Name (Legal Business Name): SANAZ N. ZOLGHADRI D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6315 BEADNELL WAY
SAN DIEGO CA
92117-4107
US

IV. Provider business mailing address

6315 BEADNELL WAY
SAN DIEGO CA
92117-4107
US

V. Phone/Fax

Practice location:
  • Phone: 858-634-4224
  • Fax: 858-634-4223
Mailing address:
  • Phone: 858-634-4224
  • Fax: 858-634-4223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number29730
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: