Healthcare Provider Details

I. General information

NPI: 1003291832
Provider Name (Legal Business Name): EDWARD SHIBLI AZAR DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2015
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 N CAMPUS AVE
ONTARIO CA
91764-3302
US

IV. Provider business mailing address

534 N CAMPUS AVE
ONTARIO CA
91764-3302
US

V. Phone/Fax

Practice location:
  • Phone: 213-537-2927
  • Fax:
Mailing address:
  • Phone: 213-537-2927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE5241
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: