=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730245358
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SIAMAK ZAMANI M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2006
-----------------------------------------------------
Last Update Date | 01/21/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 29873 SANTA MARGARITA PKWY STE 100
-----------------------------------------------------
City | RANCHO SANTA MARGARITA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92688-3626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-589-9114
-----------------------------------------------------
Fax | 949-421-0763
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 844842 SUITE 130
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90084-4842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-478-6675
-----------------------------------------------------
Fax | 866-877-6813
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | A93944
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------