Provider Demographics
NPI:1932137544
Name:MAHDI, TAREK ZAKI (MD)
Entity Type:Individual
Prefix:DR
First Name:TAREK
Middle Name:ZAKI
Last Name:MAHDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-3829
Mailing Address - Country:US
Mailing Address - Phone:951-781-6335
Mailing Address - Fax:951-781-6365
Practice Address - Street 1:4310 ORANGE ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3829
Practice Address - Country:US
Practice Address - Phone:951-781-6335
Practice Address - Fax:951-208-7244
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53772207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A537720Medicaid
BM4885274OtherDEA #
BM4885274OtherDEA #
CA00A537720Medicaid