Organization
BASSAM MOUAZZEN M.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BASSAM MOUAZZEN M.D. (PRESIDENT)
(626) 852-9986
Entity
Organization
Contact information
Practice address
415 W ROUTE 66, SUITE 101, GLENDORA, CA 91740-4335
(626) 852-9986
Mailing address
PO BOX 1939, GLENDORA, CA 91740-1939
(626) 852-9986
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
C43066
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00C430661
—
CA
Enumeration date
06/03/2008
Last updated
06/03/2008
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