Provider Demographics
NPI:1578077400
Name:ZAKIAT DAROJAT PA
Entity Type:Organization
Organization Name:ZAKIAT DAROJAT PA
Other - Org Name:RANCHO SANTA MARGARITA OSTEOPATHIC AND INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ZAKIAT
Authorized Official - Middle Name:NUR-DAROJAT
Authorized Official - Last Name:JALILVAND
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:949-923-0608
Mailing Address - Street 1:32742 COPPERCREST DR
Mailing Address - Street 2:
Mailing Address - City:TRABUCO CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:92679-3373
Mailing Address - Country:US
Mailing Address - Phone:949-923-0608
Mailing Address - Fax:
Practice Address - Street 1:30212 TOMAS STE 180
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-2174
Practice Address - Country:US
Practice Address - Phone:949-923-0608
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A12141207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty