| Tarek Ezzeddine Md Inc | |
|
10841 White Oak Ave Ste 103 Rancho Cucamonga CA 91730-3817 | |
| (909) 360-4722 | |
| (909) 360-4721 |
| Full Name | Tarek Ezzeddine Md Inc |
|---|---|
| Speciality | General Practice |
| Location | 10841 White Oak Ave Ste 103, Rancho Cucamonga, California |
| Authorized Official Name and Position | Tarek Ezzeddine (PRESIDENT) |
| Authorized Official Contact | 8108145600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tarek Ezzeddine Md Inc 10841 White Oak Ave Ste 103 Rancho Cucamonga CA 91730-3817 Ph: (909) 360-4722 | Tarek Ezzeddine Md Inc 10841 White Oak Ave Ste 103 Rancho Cucamonga CA 91730-3817 Ph: (909) 360-4722 |
| NPI Number | 1548701287 |
|---|---|
| Provider Enumeration Date | 03/14/2017 |
| Last Update Date | 01/06/2020 |
| Medicare PECOS PAC ID | 8729364658 |
|---|---|
| Medicare Enrollment ID | O20180607001706 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548701287 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | C133690 (California) | Primary |
| Provider Name | Tarek M Ezzeddine |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1740471879 PECOS PAC ID: 7315026697 Enrollment ID: I20151119000879 |
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