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General NPI Number Information
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NPI Number | 1558805671
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Entity Type | Organization
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Legal Business Name | MAZEN MUNIR MD INC.
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Dates
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Enumeration Date | 12/08/2016
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Last Update Date | 12/08/2016
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Provider Practice Location Address
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Address Line | 10165 E. FOOTHILL BLVD SUITE 8
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-0341
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Country | US
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Telephone | 760-242-5500
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Fax | 760-242-5506
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Provider Business Mailing Address
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Address Line | 5025 RODEO RD
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91737-2408
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Country | US
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Telephone | 760-242-5000
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Fax | 760-242-5506
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Authorized Official
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Title or Position | CEO
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Name | DR. MAZEN MUNIR
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Credential | MD
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Telephone | 760-242-5500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A101460
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License Number State | CA
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