NPIMap

Individual provider Active NPI

Galib Mirza, DO

  • Internal Medicine Physician
  • Glendora, CA
National Provider Identifier
1215518782
Registry record updated Jan 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
20A22579 Issued in CA
Practice address
210 S Grand Ave Ste 400
Glendora, CA 91741-4279
Phone
(626) 963-4149
NPI assigned
Apr 16, 2021
Last updated
Jan 17, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2025

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 20A22579 CA Primary

Addresses

Primary practice location

210 S Grand Ave Ste 400
Glendora, CA 91741-4279

Mailing address

4001 N 3Rd St Ste 290
Phoenix, AZ 85012-2071
Phone (316) 680-9119

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, CA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240125000033 AZ Practitioner - General Practice 5698128791 Reassigns benefits to 1 organization
I20240829004388 CA Practitioner - Internal Medicine 5698128791 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Arizona College of Osteopathic Medicine Mid Western University, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Emanate Health Medical Care FoundationGroup PAC ID 9830544980, 85 clinicians
Gap Post-Acute Care ServicesGroup PAC ID 9830619444, 14 clinicians

Practice addresses (Care Compare)

1115 S Sunset Ave
West Covina, CA 91790-3940

14857 Roscoe Blvd
Panorama City, CA 91402-4617
Phone (818) 667-6488

412 W Carroll Ave
Suite 108
Glendora, CA 91741-4707
Phone (626) 852-0411

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20A22579CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Signify Health Medical Associates of California, PC General Practice CurrentSince Feb 1, 2025 Accepting new patients
Gap Post-Acute Care Services Internal Medicine CurrentSince Mar 15, 2025 Accepting new patients
Lakewood Hospitalist Medical Group, Inc Internal Medicine CurrentSince Jan 1, 2025 Accepting new patients
Emanate Health Medical Care Foundation CurrentSince Sep 16, 2024 Accepting new patients
Signify Health, LLC General Practice CurrentSince Jan 11, 2024 Accepting new patients
Emanate Health Medical Group General Practice Past Accepting new patients

Locations

2705 S Alma School Rd
Chandler, AZ 85286
Phone (480) 820-7246

1041 W Badillo St
Ste 104
Covina, CA 91722
Phone (626) 732-4168

210 S Grand Ave
Ste 302
Glendora, CA 91741
Phone (626) 963-4149

210 S Grand Ave
Ste 400
Glendora, CA 91741
Phone (626) 335-3527

3700 South St
Lakewood, CA 90712
Phone (562) 424-2900

818 W 7th St
Ste 930
Los Angeles, CA 90017
Phone (800) 525-9202

14857 Roscoe Blvd
Panorama City, CA 91402
Phone (818) 667-6488

505 Montgomery St
Fl 10
San Francisco, CA 94111
Phone (503) 427-8095

1115 S Sunset Ave
Ste 200
West Covina, CA 91790
Phone (626) 732-8390

4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 6

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 8

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": "1618531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737072000000",
    "number": "1215518782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4001 N 3RD ST STE 290",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122071",
            "telephone_number": "316-680-9119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 S GRAND AVE STE 400",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917414279",
            "telephone_number": "626-963-4149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRZA",
        "first_name": "GALIB",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-16",
        "last_updated": "2025-01-17",
        "certification_date": "2025-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "20A22579",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendora, CA

Sources for this page

Verify at the official NPI Registry.