Provider Demographics
NPI:1457442659
Name:ZAGHA, MAURICE T (MD)
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:T
Last Name:ZAGHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MAURICE
Other - Middle Name:T
Other - Last Name:ZAGHA,INC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:16133 VENTURA BLVD
Mailing Address - Street 2:SUITE 300
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
Practice Address - Street 2:SUITE 300
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34602207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A84660Medicare UPIN