Provider Demographics
NPI:1124728241
Name:IMAM, ZARAH AFZAL (MS)
Entity type:Individual
Prefix:
First Name:ZARAH
Middle Name:AFZAL
Last Name:IMAM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28441 CALLE PINATA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-6326
Mailing Address - Country:US
Mailing Address - Phone:818-577-3987
Mailing Address - Fax:
Practice Address - Street 1:28441 CALLE PINATA
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-6326
Practice Address - Country:US
Practice Address - Phone:818-577-3987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist