Provider Demographics
NPI:1356655492
Name:HAMID ZADEH MD INC
Entity Type:Organization
Organization Name:HAMID ZADEH MD INC
Other - Org Name:HAMID ZADEH MD INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:TAVAKOLI
Authorized Official - Last Name:STAUF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-550-6327
Mailing Address - Street 1:2435 MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:CA
Mailing Address - Zip Code:92251-9599
Mailing Address - Country:US
Mailing Address - Phone:760-550-6327
Mailing Address - Fax:760-550-6331
Practice Address - Street 1:2435 MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:CA
Practice Address - Zip Code:92251-9599
Practice Address - Country:US
Practice Address - Phone:760-550-6327
Practice Address - Fax:760-550-6331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-30
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101245207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty