Healthcare Provider Details

I. General information

NPI: 1902039472
Provider Name (Legal Business Name): ZAUHER KARIM-MAHALATI MD, L.AC, DOM, ND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2009
Last Update Date: 09/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 E 2ND AVE C/O CHANTILLY HEALTH & WELLNESS
WILLIAMSON WV
25661
US

IV. Provider business mailing address

PO BOX 20307 C/O CHANTILLY HEALTH
TAMPA FL
33622-0307
US

V. Phone/Fax

Practice location:
  • Phone: 304-218-1779
  • Fax: 727-596-4514
Mailing address:
  • Phone: 304-218-1779
  • Fax: 727-596-4514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberCNA191405
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number96190
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNAT1000173
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: