Provider Demographics
NPI:1689333205
Name:ZALZALI, MAYA
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:ZALZALI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 FEATHER RDG
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-5184
Mailing Address - Country:US
Mailing Address - Phone:949-609-9559
Mailing Address - Fax:
Practice Address - Street 1:74 FEATHER RDG
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-5184
Practice Address - Country:US
Practice Address - Phone:949-302-2645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84705183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1063669544OtherWALGREENS