Provider Demographics
NPI:1144301532
Name:QAWI, JALEEL (MD)
Entity type:Individual
Prefix:
First Name:JALEEL
Middle Name:
Last Name:QAWI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2837, E, HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WESTCOVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791
Mailing Address - Country:US
Mailing Address - Phone:626-918-9670
Mailing Address - Fax:626-859-2248
Practice Address - Street 1:315 N 3RD AVE STE 102
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-1901
Practice Address - Country:US
Practice Address - Phone:626-859-2249
Practice Address - Fax:626-859-2248
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51551207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A515510Medicaid
CAC11368Medicare UPIN
CAA51551Medicare PIN