Provider Demographics
NPI:1699507160
Name:WASIM MOUAZZEN M.D., INC.
Entity type:Organization
Organization Name:WASIM MOUAZZEN M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WASIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUAZZEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-327-2763
Mailing Address - Street 1:1239 FOXGLOVE CT
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-6605
Mailing Address - Country:US
Mailing Address - Phone:626-327-2763
Mailing Address - Fax:
Practice Address - Street 1:415 W ROUTE 66 STE 101
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-4335
Practice Address - Country:US
Practice Address - Phone:626-327-2763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-14
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care