=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679832091
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ZAINAB AJEENA MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2012
-----------------------------------------------------
Last Update Date | 03/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5730 PACKARD AVE STE 500
-----------------------------------------------------
City | MARYSVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95901-7119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-749-3242
-----------------------------------------------------
Fax | 530-767-1020
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1114 YUBA ST STE 220
-----------------------------------------------------
City | MARYSVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95901-4838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-749-3242
-----------------------------------------------------
Fax | 530-743-5044
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | A148146
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------