Provider Demographics
NPI:1245572619
Name:ZARDOUZ, DIANA
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:ZARDOUZ
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:PO BOX 28883
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92799-8883
Mailing Address - Country:US
Mailing Address - Phone:949-529-1038
Mailing Address - Fax:
Practice Address - Street 1:18377 BEACH BLVD STE 106B
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1349
Practice Address - Country:US
Practice Address - Phone:714-847-8660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-22
Last Update Date:2019-06-10
Deactivation Date:2013-06-05
Deactivation Code:
Reactivation Date:2014-02-11
Provider Licenses
StateLicense IDTaxonomies
CA62577122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist