Provider Demographics
NPI:1598154478
Name:ZAMIL, TAQIALDEEN (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:TAQIALDEEN
Middle Name:
Last Name:ZAMIL
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S BILLIE JO CIR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-3101
Mailing Address - Country:US
Mailing Address - Phone:714-248-3764
Mailing Address - Fax:512-521-0386
Practice Address - Street 1:1310 W STEWART DR STE 301
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3838
Practice Address - Country:US
Practice Address - Phone:714-712-0711
Practice Address - Fax:657-224-4781
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM03557363LP0808X
CA95003782363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM76078OtherRN LICENSE
NMCNP-03557OtherNURSE PRACTITIONER LICENSE
OR202100283RNOtherRN LICENSE
WAAP61115151OtherNP LICENSE
OR202106041NP-PPOtherNP LICENSE
AZ249949OtherRN LICENSE
CA828251OtherRN LICENSE
WARN61107445OtherRN LICENSE
AZ249949OtherNP LICENSE
WA61115151OtherNP LICENSE
2015020476OtherAMERICAN NURSING CREDENTIALING CENTER (ANCC)
CA95003782OtherNP LICENSE