Healthcare Provider Details

I. General information

NPI: 1487715694
Provider Name (Legal Business Name): ADIL MAZHAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 S SUNSET AVE
WEST COVINA CA
91790-3940
US

IV. Provider business mailing address

PO BOX 635
WEST COVINA CA
91793-0635
US

V. Phone/Fax

Practice location:
  • Phone: 626-814-2473
  • Fax:
Mailing address:
  • Phone: 626-813-9988
  • Fax: 626-813-0049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA81151
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberA81151
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: