Provider Demographics
NPI:1881175248
Name:THE PILL CLUB MEDICAL GROUP PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:THE PILL CLUB MEDICAL GROUP PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAJAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ZALZALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-285-6927
Mailing Address - Street 1:951 MARINERS ISLAND BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94404-1560
Mailing Address - Country:US
Mailing Address - Phone:650-285-6927
Mailing Address - Fax:888-352-7383
Practice Address - Street 1:100 CHARLES EWING BLVD STE 160
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08628-3456
Practice Address - Country:US
Practice Address - Phone:650-285-6927
Practice Address - Fax:888-352-7383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-23
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty