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General NPI Number Information
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NPI Number | 1578077400
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Entity Type | Organization
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Legal Business Name | ZAKIAT DAROJAT PA
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Dates
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Enumeration Date | 11/30/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 30212 TOMAS STE 180
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City | RANCHO SANTA MARGARITA
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State | CA
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Zip | 92688-2174
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Country | US
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Telephone | 949-923-0608
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Fax |
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Provider Business Mailing Address
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Address Line | 32742 COPPERCREST DR
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City | TRABUCO CANYON
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State | CA
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Zip | 92679-3373
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Country | US
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Telephone | 949-923-0608
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ZAKIAT NUR-DAROJAT JALILVAND
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Credential | DO
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Telephone | 949-923-0608
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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 | 20A12141
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License Number State | CA
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