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General NPI Number Information
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NPI Number | 1740471879
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Entity Type | Individual
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Provider Name | TAREK EZZEDDINE MD
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Gender | Male
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 8250 WHITE OAK AVE STE 106
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-7679
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Country | US
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Telephone | 909-360-4722
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Fax | 909-360-4721
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Provider Business Mailing Address
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Address Line | 6131 SOFTWIND PL
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91737-7701
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Country | US
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Telephone | 909-360-3124
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Fax | 909-360-4721
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | C133690
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | C133690
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License Number State | CA
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