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General NPI Number Information
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NPI Number | 1962409474
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Entity Type | Organization
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Legal Business Name | HAVEN FAMILY MEDICAL CENTER INC.
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Dates
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Enumeration Date | 06/30/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 8599 HAVEN AVE STE 101
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-4849
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Country | US
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Telephone | 909-466-8888
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Fax | 909-483-0164
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Provider Business Mailing Address
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Address Line | 8599 HAVEN AVE STE # 101
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-4849
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Country | US
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Telephone | 909-466-8888
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Fax | 909-483-0164
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Authorized Official
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Title or Position | FAMILY PRACTICE
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Name | DR. ZAHER AZZAWI
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Credential | M.D.
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Telephone | 909-466-8888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State | CA
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