Provider Demographics
NPI:1164779781
Name:MAURICE T. ZAGHA, M.D., INC
Entity Type:Organization
Organization Name:MAURICE T. ZAGHA, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:T
Authorized Official - Last Name:ZAGHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-907-6525
Mailing Address - Street 1:16133 VENTURA BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2428
Mailing Address - Country:US
Mailing Address - Phone:818-907-6525
Mailing Address - Fax:818-907-7418
Practice Address - Street 1:16133 VENTURA BLVD STE 300
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2428
Practice Address - Country:US
Practice Address - Phone:818-907-6525
Practice Address - Fax:818-907-7418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34602261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1457442659Medicare PIN