Healthcare Provider Details

I. General information

NPI: 1295421295
Provider Name (Legal Business Name): MARIGOLD ZOGHZOGHI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 04/30/2023
Certification Date: 04/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14440 CEDAR RD
CLEVELAND HEIGHTS OH
44121-3329
US

IV. Provider business mailing address

14440 CEDAR RD
CLEVELAND OH
44121-3329
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 866-389-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0033391
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: