Organization
FARES ELGHAZI MD MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FARES ELGHAZI M.D. (OWNER)
(909) 620-7876
Entity
Organization
Contact information
Practice address
1818 N ORANGE GROVE AVE, SUITE 300, POMONA, CA 91767-3028
(909) 620-7876
(909) 463-2434
Mailing address
1818 N ORANGE GROVE AVE, SUITE 300, POMONA, CA 91767-3028
(909) 620-7876
(909) 463-2434
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
C042219
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00C422190
—
CA
Enumeration date
05/12/2010
Last updated
06/18/2010
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