Provider Demographics
NPI:1932795556
Name:JASIM, ZEYAD
Entity Type:Individual
Prefix:
First Name:ZEYAD
Middle Name:
Last Name:JASIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7434 ASHFORD PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-4816
Mailing Address - Country:US
Mailing Address - Phone:619-328-7145
Mailing Address - Fax:
Practice Address - Street 1:494 EL MONTE RD
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-3024
Practice Address - Country:US
Practice Address - Phone:619-328-7145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor