Healthcare Provider Details

I. General information

NPI: 1326590217
Provider Name (Legal Business Name): NATHAN ZAGHI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14124 FOOTHILL BLVD STE 103
SYLMAR CA
91342-8052
US

IV. Provider business mailing address

14124 FOOTHILL BLVD STE 103
SYLMAR CA
91342-8052
US

V. Phone/Fax

Practice location:
  • Phone: 818-574-4439
  • Fax:
Mailing address:
  • Phone: 818-574-4439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number100825
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: