Healthcare Provider Details

I. General information

NPI: 1972673846
Provider Name (Legal Business Name): NASER W. AZAR, M.D., INC.,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2071 COMPTON AVE STE 101102
CORONA CA
92881-7278
US

IV. Provider business mailing address

PO BOX 1245
COLTON CA
92324-0822
US

V. Phone/Fax

Practice location:
  • Phone: 951-549-0900
  • Fax: 951-278-8552
Mailing address:
  • Phone: 951-549-0900
  • Fax: 951-278-8552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NASER WADIE AZAR
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 951-549-0900