Provider Demographics
NPI:1558805671
Name:MAZEN MUNIR MD INC.
Entity Type:Organization
Organization Name:MAZEN MUNIR MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MAZEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-242-5500
Mailing Address - Street 1:5025 RODEO RD
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-2408
Mailing Address - Country:US
Mailing Address - Phone:760-242-5000
Mailing Address - Fax:760-242-5506
Practice Address - Street 1:10165 E. FOOTHILL BLVD
Practice Address - Street 2:SUITE 8
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0341
Practice Address - Country:US
Practice Address - Phone:760-242-5500
Practice Address - Fax:760-242-5506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101460207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty