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General NPI Number Information
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NPI Number | 1003916727
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Entity Type | Individual
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Provider Name | M. MAZEN JAMAL M.D., M.P.H.
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Gender | Male
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Dates
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Enumeration Date | 09/23/2006
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Last Update Date | 06/24/2021
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Provider Practice Location Address
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Address Line | 2097 COMPTON AVE STE 103
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City | CORONA
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State | CA
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Zip | 92881-7289
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Country | US
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Telephone | 951-934-0505
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Fax | 951-444-7749
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Provider Business Mailing Address
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Address Line | 29 PRAIRE
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City | IRVIN
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State | CA
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Zip | 92618
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Country | US
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Telephone | 949-813-5115
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Fax | 949-825-5189
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 12734
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | A46078
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License Number State | CA
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