Healthcare Provider Details

I. General information

NPI: 1306296074
Provider Name (Legal Business Name): SAFWAN GAZNABI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11234 ANDERSON ST # 6100
LOMA LINDA CA
92350-1716
US

IV. Provider business mailing address

11234 ANDERSON ST # 6100
LOMA LINDA CA
92350-1716
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-4200
  • Fax: 909-558-4212
Mailing address:
  • Phone: 909-558-4200
  • Fax: 909-558-4212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number036152136
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036152136
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA196715
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036152136
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: