Healthcare Provider Details

I. General information

NPI: 1467046771
Provider Name (Legal Business Name): AZAR FOOT & ANKLE SPECIALIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
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 TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EDWARD SHIBLI AZAR
Title or Position: CEO
Credential: DPM
Phone: 213-537-2927