Provider Demographics
NPI:1225240906
Name:MORADKHAN ZOMALAN, NOEL (MD)
Entity Type:Individual
Prefix:
First Name:NOEL
Middle Name:
Last Name:MORADKHAN ZOMALAN
Suffix:
Gender:M
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:PO BOX 4398
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95352-4398
Mailing Address - Country:US
Mailing Address - Phone:209-575-4575
Mailing Address - Fax:209-575-4598
Practice Address - Street 1:2161 COLORADO AVE
Practice Address - Street 2:STE A
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2007
Practice Address - Country:US
Practice Address - Phone:209-634-9461
Practice Address - Fax:209-575-4598
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA96546207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine