Provider Demographics
NPI:1184809337
Name:AZZAWI, ZAHER (MD)
Entity type:Individual
Prefix:DR
First Name:ZAHER
Middle Name:
Last Name:AZZAWI
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 1:10841 WHITE OAK AVE
Mailing Address - Street 2:STE 107
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3811
Mailing Address - Country:US
Mailing Address - Phone:909-483-8361
Mailing Address - Fax:909-483-2070
Practice Address - Street 1:10841 WHITE OAK AVE
Practice Address - Street 2:STE # 107
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3811
Practice Address - Country:US
Practice Address - Phone:909-483-8361
Practice Address - Fax:909-483-2070
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48743174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ02985ZMedicare PIN