1962561274 NPI number — PROF. FAITH SALIH ZADA MD

Table of content: PROF. FAITH SALIH ZADA MD (NPI 1962561274)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962561274 NPI number — PROF. FAITH SALIH ZADA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZADA
Provider First Name:
FAITH
Provider Middle Name:
SALIH
Provider Name Prefix Text:
PROF.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1962561274
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1026
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALOS VERDES ESTATES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90274
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3611 MARTIN LUTHER KING BLVD
Provider Second Line Business Practice Location Address:
#105
Provider Business Practice Location Address City Name:
LYNWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-639-3836
Provider Business Practice Location Address Fax Number:
310-378-4458
Provider Enumeration Date:
12/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X , with the licence number:  A30138 , 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: 00A301380 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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