Provider Demographics
NPI:1164403010
Name:ZEITOUNI, NATHALIE (MD)
Entity Type:Individual
Prefix:
First Name:NATHALIE
Middle Name:
Last Name:ZEITOUNI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-2155
Mailing Address - Country:US
Mailing Address - Phone:602-406-8222
Mailing Address - Fax:602-406-0671
Practice Address - Street 1:625 N 6TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-2155
Practice Address - Country:US
Practice Address - Phone:602-406-8222
Practice Address - Fax:602-406-0671
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213284207N00000X
AZ48274207N00000X, 207ND0101X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01934734Medicaid
NY01934734Medicaid