Provider Demographics
NPI:1205943446
Name:MUNIR, MAZEN K (MD)
Entity type:Individual
Prefix:
First Name:MAZEN
Middle Name:K
Last Name:MUNIR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:18144 US HIGHWAY 18
Mailing Address - Street 2:SUITE 140
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2212
Mailing Address - Country:US
Mailing Address - Phone:760-242-5500
Mailing Address - Fax:760-242-5506
Practice Address - Street 1:18144 US HIGHWAY 18
Practice Address - Street 2:SUITE 140
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2212
Practice Address - Country:US
Practice Address - Phone:760-242-5500
Practice Address - Fax:760-242-5506
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2013-07-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MEEC05060207Q00000X
CAA101460207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A1014600Medicare PIN