MEDICARE: DR. EDWARD SHIBLI AZAR DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	E5241	CA

General Provider Information

NPI Number	:	1003291832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD SHIBLI AZAR DPM

Provider Business Mailing Address
First Line	:	9675 MONTE VISTA AVE STE D
Second Line	:
City	:	MONTCLAIR
State	:	CA
Zip	:	91763-2213
Country	:	US
Telephone Number	:	213-537-2927
Fax Number	:

Provider Business Practice Location Address
First Line	:	9675 MONTE VISTA AVE STE D
Second Line	:
City	:	MONTCLAIR
State	:	CA
Zip	:	91763-2213
Country	:	US
Telephone Number	:	213-537-2927
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2015
Last Update Date	:	05/25/2025

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