Provider Demographics
NPI:1689216020
Name:AHMAD, ZEESHAN (PA-C)
Entity Type:Individual
Prefix:
First Name:ZEESHAN
Middle Name:
Last Name:AHMAD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 CEDAR AVE APT 14
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-5303
Mailing Address - Country:US
Mailing Address - Phone:530-635-0231
Mailing Address - Fax:
Practice Address - Street 1:1101 E BROADWAY STE 201
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1396
Practice Address - Country:US
Practice Address - Phone:818-500-9286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA57363363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant