Provider Demographics
NPI:1003140948
Name:MAWAD, JOE (MD)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:
Last Name:MAWAD
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 1:1800 WESTERN AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92411-1353
Mailing Address - Country:US
Mailing Address - Phone:909-474-9952
Mailing Address - Fax:909-474-9951
Practice Address - Street 1:1800 WESTERN AVE STE 204
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411
Practice Address - Country:US
Practice Address - Phone:909-474-9952
Practice Address - Fax:909-474-9951
Is Sole Proprietor?:No
Enumeration Date:2009-09-24
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA109432207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A1094320Medicaid