Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | E5241 | CA |
NPI | 1003291832 |
---|---|
Provider Name | Dr. Edward Shibli Azar |
First Address | Montclair, CA 91763-2213 |
Second Address | Montclair, CA 91763-2213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2015 |
Last Update Date | 09/11/2021 |