Individual
BASSAM MOUAZZEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
415 W ROUTE 66, SUITE 101, GLENDORA, CA 91740-4335
(626) 852-9986
(626) 963-2220
Mailing address
PO BOX 1939, GLENDORA, CA 91740-1939
(626) 852-9986
(626) 963-2220
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
C43066
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1625227
—
CA
01
—
RHC140778
FLOUROSCOPY
CA
Enumeration date
09/27/2006
Last updated
03/07/2023
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