Provider Demographics
NPI:1912666827
Name:ALIDAD ZADEH DO, INC.
Entity Type:Organization
Organization Name:ALIDAD ZADEH DO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIDAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:442-283-5861
Mailing Address - Street 1:1600 S IMPERIAL AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-4242
Mailing Address - Country:US
Mailing Address - Phone:442-283-5861
Mailing Address - Fax:442-283-5862
Practice Address - Street 1:1600 S IMPERIAL AVE STE 5
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4242
Practice Address - Country:US
Practice Address - Phone:442-283-5861
Practice Address - Fax:442-283-5862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-08
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & NeuropsychiatryGroup - Single Specialty