Provider Demographics
NPI:1003916727
Name:JAMAL, M. MAZEN (MD, MPH)
Entity Type:Individual
Prefix:
First Name:M. MAZEN
Middle Name:
Last Name:JAMAL
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:MOHAMMAD MAZEN
Other - Middle Name:
Other - Last Name:JAMAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:29 PRAIRE
Mailing Address - Street 2:
Mailing Address - City:IRVIN
Mailing Address - State:CA
Mailing Address - Zip Code:92618
Mailing Address - Country:US
Mailing Address - Phone:949-813-5115
Mailing Address - Fax:949-825-5189
Practice Address - Street 1:2097 COMPTON AVE STE 103
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-7289
Practice Address - Country:US
Practice Address - Phone:951-934-0505
Practice Address - Fax:951-444-7749
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12734207RG0100X
CAA46078207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA46078AOtherPPIN
CAWA46078AOtherPPIN