Provider Demographics
NPI:1528398369
Name:M. MAZEN JAMAL, M.D., INC.
Entity Type:Organization
Organization Name:M. MAZEN JAMAL, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:M.
Authorized Official - Middle Name:MAZEN
Authorized Official - Last Name:JAMAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-920-0444
Mailing Address - Street 1:1148 SAN BERNARDINO RD
Mailing Address - Street 2:SUITE202
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4943
Mailing Address - Country:US
Mailing Address - Phone:909-920-0444
Mailing Address - Fax:909-920-5044
Practice Address - Street 1:1148 SAN BERNARDINO RD
Practice Address - Street 2:SUITE202
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4943
Practice Address - Country:US
Practice Address - Phone:909-920-0444
Practice Address - Fax:909-920-5044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46078207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty