Organization
HAVEN FAMILY MEDICAL CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ZAHER AZZAWI (CEO/PRESIDENT)
(909) 466-8888
Entity
Organization
Contact information
Practice address
8599 HAVEN AVE, STE 101, RANCHO CUCAMONGA, CA 91730-4849
(909) 466-8888
(909) 483-0164
Mailing address
8599 HAVEN AVE, STE 101, RANCHO CUCAMONGA, CA 91730-4849
(909) 466-8888
(909) 483-0164
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
A487430
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1048460
UNITED MPIN
CA
01
—
1349459
UNITED HEALTHCARE GROUP #
CA
01
—
A487430
BLUE CROSS BLUE SHIELD
CA
Enumeration date
09/08/2006
Last updated
01/07/2008
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