Provider Demographics
NPI:1376866707
Name:AHMAD, ZEINELDIN (DPM)
Entity Type:Individual
Prefix:
First Name:ZEINELDIN
Middle Name:
Last Name:AHMAD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 LONE TREE WAY
Mailing Address - Street 2:STE 206
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-5559
Mailing Address - Country:US
Mailing Address - Phone:925-978-2738
Mailing Address - Fax:925-753-1984
Practice Address - Street 1:1300 BANCROFT AVE
Practice Address - Street 2:SUITE#103
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-5147
Practice Address - Country:US
Practice Address - Phone:510-483-3390
Practice Address - Fax:510-394-6402
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-12
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4910213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5146740Medicaid
CAEJ469AMedicare PIN