=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285577155
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AHMAD ZEITOUN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2026
-----------------------------------------------------
Last Update Date | 04/14/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 636 W SOUTHERN AVE
-----------------------------------------------------
City | MESA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85210-5005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-969-5817
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6932 E SUGARLOAF CIR
-----------------------------------------------------
City | MESA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85207-0937
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-516-8601
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 279941
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------