Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 20A14885 | CA |
NPI | 1003202920 |
---|---|
Provider Name | Omid Zebarjadi |
First Address | Menifee, CA 92585-4002 |
Second Address | Menifee, CA 92585-4002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2015 |
Last Update Date | 14/02/2022 |