Provider Demographics
NPI:1548003379
Name:ALMOUAZZEN, ADNAN (NP)
Entity type:Individual
Prefix:MR
First Name:ADNAN
Middle Name:
Last Name:ALMOUAZZEN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 LOBELIA AVE
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91784-7386
Mailing Address - Country:US
Mailing Address - Phone:909-912-2630
Mailing Address - Fax:
Practice Address - Street 1:250 E RINCON ST STE 106
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-1363
Practice Address - Country:US
Practice Address - Phone:951-339-8459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027419363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily