Healthcare Provider Details

I. General information

NPI: 1508376013
Provider Name (Legal Business Name): MARWAN ZOGHBI MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2017
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3622 W PACKWOOD AVE
VISALIA CA
93277-5010
US

IV. Provider business mailing address

3632 W PACKWOOD AVE
VISALIA CA
93277-5033
US

V. Phone/Fax

Practice location:
  • Phone: 559-382-3820
  • Fax: 559-224-1012
Mailing address:
  • Phone: 559-734-6701
  • Fax: 559-732-3211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberA142501
License Number StateCA

VIII. Authorized Official

Name: DR. MARWAN B ZOGHBI
Title or Position: CEO
Credential: MD
Phone: 559-699-1739