Healthcare Provider Details

I. General information

NPI: 1861726135
Provider Name (Legal Business Name): MOJGAN FATEMEH ZAFARY-DAFTARY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2009
Last Update Date: 12/03/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1687 ERRINGER RD 102
SIMI VALLEY CA
93065-6508
US

IV. Provider business mailing address

1719 SKYRIDGE CT
NEWBURY PARK CA
91320-4558
US

V. Phone/Fax

Practice location:
  • Phone: 805-341-1119
  • Fax:
Mailing address:
  • Phone: 805-341-1119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA105365
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: