Provider Demographics
NPI:1518679471
Name:ZAKIAT N JALILVAND DO INC
Entity Type:Organization
Organization Name:ZAKIAT N JALILVAND DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ZAKIAT
Authorized Official - Middle Name:
Authorized Official - Last Name:JALILVAND
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:949-923-0608
Mailing Address - Street 1:4241 MONTGOMERY DR # 120
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-5306
Mailing Address - Country:US
Mailing Address - Phone:949-272-6687
Mailing Address - Fax:732-898-0513
Practice Address - Street 1:10 WOODLAND RD
Practice Address - Street 2:
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574-9554
Practice Address - Country:US
Practice Address - Phone:707-963-6421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty