TAREK EZZEDDINE MD INC (NPI# 1548701287) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548701287 |
| Entity Type | Organization |
| Organization Name | TAREK EZZEDDINE MD INC |
| Practice Address |
10841 White Oak Ave Ste 103 Rancho Cucamonga CA 91730-3817 |
| Practice Telephone | 9093604722 |
| Practice Fax Number | 9093604721 |
| Mailing Telephone | 9093604722 |
| Enumeration Date | 2017-03-14 |
| Last Update Date | 2020-01-06 |
| Authorized Official Name | DR. TAREK EZZEDDINE (PRESIDENT) |
| Authorized Official Telephone | 8108145600 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | C133690 | CA | Allopathic & Osteopathic Physicians |
| Street Address |
10841 WHITE OAK AVE STE 103 |
| City | RANCHO CUCAMONGA |
| State | CA |
| Zip Code | 91730-3817 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740471879 | Tarek Ezzeddine | Internal Medicine | 10841 White Oak Ave Ste 103, Rancho Cucamonga, CA 91730 | 2007-08-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
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| 1982235263 | Mel Latone Family Counseling, Inc. | Marriage & Family Therapist | 9033 Base Line Road, Suite M, Rancho Cucamonga, CA 91730 | 2020-01-27 |
| 1205471240 | Breena Nakamoto | Social Worker | 9645 Arrow Route, Building 5, Suite A, Rancho Cucamonga, CA 91730 | 2019-11-13 |
| 1497300180 | Laura Estela Le | Behavior Technician | 8350 Archilbald Ave Ste 110, Rancho Cucamonga, CA 91730 | 2019-08-08 |
| 1336792100 | Swan Psychological Services, Inc. | Psychologist | 8333 E. Foothill Blvd., Suite 109, Rancho Cucamonga, CA 91730 | 2019-07-22 |
| 1568023745 | Mariah Wright | Behavior Technician | 10532 Arcacia St, B-11, Rancho Cucamonga, CA 91730 | 2019-06-27 |
| 1770140378 | Amanda Ware | Clinic/Center | 9333 Fairway View Place Suite 101, Rancho Cucamonga, CA 91730 | 2019-05-20 |
| 1265995435 | Collaborative Autism Management Programs Inc. | Community/Behavioral Health | 9360 Santa Anita Ave Ste 104, Rancho Cucamonga, CA 91730 | 2019-04-12 |
| 1700361326 | Brittany Rhone | Behavioral Analyst | 933 Baseline Rd, Rancho Cucamonga, CA 91730 | 2018-09-28 |
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| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
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| 1992782163 | Rolando G. Uykimpang | General Practice | 10399 Lemon Ave Ste 102b, Rancho Cucamonga, CA 91737-3771 | 2005-12-28 |
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| City | RANCHO CUCAMONGA |
| Zip Code | 91730 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.