Provider Demographics
NPI:1992810931
Name:DEEB, ZIAD L (MD)
Entity type:Individual
Prefix:
First Name:ZIAD
Middle Name:L
Last Name:DEEB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17360 BROOKHURST STREET
Mailing Address - Street 2:ATTN: CREDENTIALING DEPARTMENT
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-3720
Mailing Address - Country:US
Mailing Address - Phone:657-241-3592
Mailing Address - Fax:714-665-4614
Practice Address - Street 1:2801 ATLANTIC AVENUE
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90801
Practice Address - Country:US
Practice Address - Phone:562-933-1550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC535572085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0839267Medicaid
OHB34991Medicare UPIN