Healthcare Provider Details

I. General information

NPI: 1003202920
Provider Name (Legal Business Name): OMID ZEBARJADI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2015
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27699 JEFFERSON AVE STE 305
TEMECULA CA
92590-2615
US

IV. Provider business mailing address

27819 SAGEBRUSH RD
MENIFEE CA
92585-4002
US

V. Phone/Fax

Practice location:
  • Phone: 951-503-8730
  • Fax: 714-410-0369
Mailing address:
  • Phone: 415-827-1483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14885
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: