Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | A109432 | CA |
NPI | 1003140948 |
---|---|
Provider Name | Joe Mawad |
First Address | San Bernardino, CA 92411-1353 |
Second Address | San Bernardino, CA 92411 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2009 |
Last Update Date | 10/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A1094320 | (05) | CA |