1922146109 NPI number — FARID ZIA PHYSICAL THERAPIST A PROFESSIONAL CORP

Table of content: (NPI 1922146109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922146109 NPI number — FARID ZIA PHYSICAL THERAPIST A PROFESSIONAL CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FARID ZIA PHYSICAL THERAPIST A PROFESSIONAL CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922146109
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3204
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL CENTRO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92244-3204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-353-3422
Provider Business Mailing Address Fax Number:
760-353-9163

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1698 CRUICKSHANK DR STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL CENTRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92243-1462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-353-3422
Provider Business Practice Location Address Fax Number:
760-353-9163
Provider Enumeration Date:
02/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ZIA
Authorized Official First Name:
FARID
Authorized Official Middle Name:
MEMAR
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
760-353-3422

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT24141 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 125159900 . This is a "U.S. DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: PT 24141 . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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