Provider Demographics
NPI:1659051977
Name:ZARGHAMPOUR, POOYA
Entity Type:Individual
Prefix:MR
First Name:POOYA
Middle Name:
Last Name:ZARGHAMPOUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5333 W DUBLIN CT
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-1905
Mailing Address - Country:US
Mailing Address - Phone:520-391-0465
Mailing Address - Fax:
Practice Address - Street 1:5333 W DUBLIN CT
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-1905
Practice Address - Country:US
Practice Address - Phone:520-391-0465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-21
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD25421154172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver