NPIMap

Individual provider Active NPI

Azhar Muttalib, M.D.

  • Internal Medicine Physician
  • Torrance, CA
National Provider Identifier
1124054721
Registry record updated Oct 13, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
E24196 Issued in CA
Practice address
23639 Hawthorne Blvd
Suite 102
Torrance, CA 90505-5930
Phone
(310) 373-9980
Fax
(310) 373-5556
NPI assigned
Jun 24, 2006
Last updated
Oct 13, 2010By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 13, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X E24196 CA Primary

Addresses

Primary practice location

23639 Hawthorne Blvd
Suite 102
Torrance, CA 90505-5930

Mailing address

23639 Hawthorne Blvd
Suite 102
Torrance, CA 90505-5930
Phone (310) 373-9980

Other identifiers 1

IdentifierTypeStateIssuer
2591934MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040520001365 CA Practitioner - Internal Medicine 1759372410 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Azhar Muttalib M D a Professional CorporationGroup PAC ID 8022326693, 2 clinicians

Practice addresses (Care Compare)

23639 Hawthorne Blvd
Suite 102
Torrance, CA 90505-5985

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
E24196CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Azhar Muttalib MD a Professional Corporation Internal Medicine CurrentSince Nov 1, 2015 Accepting new patients
Torrance Memorial Medical Center Past Accepting new patients
Providence Health System Southern California Past Accepting new patients

Locations

23639 Hawthorne Blvd
Ste 102
Torrance, CA 90505
Phone (310) 373-9980

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Torrance Care Center WestTorrance, CA, CCN 055952 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 1, 2015
Jan 1, 2015
Beachside Post AcuteTorrance, CA, CCN 055531 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jun 1, 2023
Jun 1, 2023

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1286928000000",
    "number": "1124054721",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23639 HAWTHORNE BLVD",
            "address_2": "SUITE 102",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905055930",
            "telephone_number": "310-373-9980",
            "fax_number": "310-373-5556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23639 HAWTHORNE BLVD",
            "address_2": "SUITE 102",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905055930",
            "telephone_number": "310-373-9980",
            "fax_number": "310-373-5556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUTTALIB",
        "first_name": "AZHAR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-24",
        "last_updated": "2010-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "E24196",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2591934",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Torrance, CA

Sources for this page

Verify at the official NPI Registry.