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General NPI Number Information
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NPI Number | 1235307141
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Entity Type | Individual
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Provider Name | ENNIS ZAITOON M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/13/2008
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Last Update Date | 09/17/2024
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Provider Practice Location Address
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Address Line | 21634 RETREAT PKWY
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City | CORONA
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State | CA
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Zip | 92883-6100
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Country | US
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Telephone | 951-493-6870
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Fax | 951-826-8157
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Provider Business Mailing Address
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Address Line | 21634 RETREAT PKWY
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City | CORONA
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State | CA
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Zip | 92883-6100
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Country | US
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Telephone | 951-493-6870
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Fax | 951-826-8157
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 01067223
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | C160730
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License Number State | CA
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