1013454495 NPI number — MARCO M ZAHEDI MD A MEDICAL CORPORATION

Table of content: (NPI 1013454495)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013454495 NPI number — MARCO M ZAHEDI MD A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARCO M ZAHEDI MD A MEDICAL CORPORATION
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:
1013454495
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3972 BARRANCA PKWY
Provider Second Line Business Mailing Address:
SUITE J #490
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92606-1204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-371-9862
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
999 N TUSTIN AVE STE 222
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA ANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92705-6506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-371-9862
Provider Business Practice Location Address Fax Number:
866-439-4879
Provider Enumeration Date:
01/24/2017

Additional Information

Authorized Official

Authorized Official Last Name:
ZAHEDI
Authorized Official First Name:
MARCO
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
949-371-9862

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  A138224 , 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)





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