Basic Information
| Provider Information | |||||||||
| NPI: | 1528398369 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | M. MAZEN JAMAL, M.D., INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1148 SAN BERNARDINO RD | ||||||||
| Address2: | SUITE202 | ||||||||
| City: | UPLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917864943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099200444 | ||||||||
| FaxNumber: | 9099205044 | ||||||||
| Practice Location | |||||||||
| Address1: | 1148 SAN BERNARDINO RD | ||||||||
| Address2: | SUITE202 | ||||||||
| City: | UPLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917864943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099200444 | ||||||||
| FaxNumber: | 9099205044 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2009 | ||||||||
| LastUpdateDate: | 12/29/2009 | ||||||||
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| AuthorizedOfficialLastName: | JAMAL | ||||||||
| AuthorizedOfficialFirstName: | M. | ||||||||
| AuthorizedOfficialMiddleName: | MAZEN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9099200444 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | A46078 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.