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NPI Code Detail

MEDICARE: MAHMOOD FATHOLLAZADEH PA-C

MEDICARE: MAHMOOD FATHOLLAZADEH PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA12070CA

General Provider Information

NPI Number : 1386711158
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAHMOOD FATHOLLAZADEH PA-C
Provider Business Mailing Address
First Line : 1850 E WASHINGTON ST
Second Line :
City : COLTON
State : CA
Zip : 92324-4621
Country : US
Telephone Number : 909-887-2991
Fax Number : 909-887-5694
Provider Business Practice Location Address
First Line : 1850 E WASHINGTON ST
Second Line :
City : COLTON
State : CA
Zip : 92324-4621
Country : US
Telephone Number : 909-887-2991
Fax Number : 909-887-5694
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2006
Last Update Date : 07/18/2023

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Directions to “ MAHMOOD FATHOLLAZADEH PA-C” Practice Location

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