Healthcare Provider Details

I. General information

NPI: 1619011392
Provider Name (Legal Business Name): AZHAR MUTTALIB MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 09/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23639 HAWTHORNE BLVD SUITE 102
TORRANCE CA
90505-5930
US

IV. Provider business mailing address

23639 HAWTHORNE BLVD SUITE 102
TORRANCE CA
90505-5930
US

V. Phone/Fax

Practice location:
  • Phone: 310-373-9980
  • Fax: 310-373-5556
Mailing address:
  • Phone: 310-373-9980
  • Fax: 310-373-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AZHAR MUTTALIB
Title or Position: DOCTOR
Credential: MD
Phone: 310-373-9980