Basic Information
| Provider Information | |||||||||
| NPI: | 1003015652 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEHQANZADA | ||||||||
| FirstName: | ZIA | ||||||||
| MiddleName: | AHMAD | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 359 REDWING DR | ||||||||
| Address2: | |||||||||
| City: | WOODLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956955868 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9168177268 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | CMR 442 | ||||||||
| Address2: | BOX 291 | ||||||||
| City: | APO | ||||||||
| State: | AE | ||||||||
| PostalCode: | 09042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 496221173440 | ||||||||
| FaxNumber: | 496221173427 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2007 | ||||||||
| LastUpdateDate: | 08/11/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 0101233249 | VA | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.