Organization
INLAND EMPIRE EXTRA CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ZAHER AZZAWI M.D (PRESIDENT)
(909) 483-8361
Entity
Organization
Contact information
Practice address
10841 WHITE OAK AVE, SUITE 107, RANCHO CUCAMONGA, CA 91730-3811
(909) 483-8361
(909) 483-2070
Mailing address
10841 WHITE OAK AVE, SUITE 107, RANCHO CUCAMONGA, CA 91730-3811
(909) 483-8361
(909) 483-2070
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
A48743
CA
305R00000X
Preferred Provider Organization
A48743
CA
Other
Enumeration date
04/19/2011
Last updated
04/19/2011
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