Provider Demographics
NPI:1982649505
Name:ZAREI, MARYAM (MD)
Entity Type:Individual
Prefix:
First Name:MARYAM
Middle Name:
Last Name:ZAREI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15725 POMERADO RD STE 218
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2060
Mailing Address - Country:US
Mailing Address - Phone:858-521-0806
Mailing Address - Fax:858-521-0808
Practice Address - Street 1:15725 POMERADO RD STE 218
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2060
Practice Address - Country:US
Practice Address - Phone:858-521-0806
Practice Address - Fax:858-521-0808
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63974207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW21715Medicare PIN
CAH44927Medicare UPIN