Mahmood Fathollazadeh, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA12070 Issued in CA

Practice address

1850 E Washington St
Colton, CA 92324-4621

Phone

(909) 887-2991

Fax

(909) 887-5694

NPI assigned

Nov 29, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Andrew W Hesseltine MD IncGroup PAC ID 8224088091, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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

• Andrew W Hesseltine, M.D., Inc

  • Pain Medicine (Anesthesiology) Physician
  • Colton, CA
  • NPI 1184766685
  Medicare reassignment Care Compare group
• Cedars-Sinai Medical Center

  • General Acute Care Hospital
  • Los Angeles, CA
  • NPI 1639172372
  NPD (past)

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689638400000",
    "number": "1386711158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1850 E WASHINGTON ST",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923244621",
            "telephone_number": "909-887-2991",
            "fax_number": "909-887-5694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 E WASHINGTON ST",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923244621",
            "telephone_number": "909-887-2991",
            "fax_number": "909-887-5694"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9961 Sierra Ave",
            "address_purpose": "LOCATION",
            "city": "Fontana",
            "state": "CA",
            "postal_code": "923356720",
            "country_code": "US",
            "telephone_number": "909-427-3910",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FATHOLLAZADEH",
        "first_name": "MAHMOOD",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-29",
        "last_updated": "2023-07-18",
        "certification_date": "2023-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA12070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• April Faris
• Blackpearl Farr
• Naghmana Farrukh, M.D.
• Alaleh Farsay Kiya, RPH
• Tasnia Faruque, MD
• Mae Rita Faure
• Madalynne Ann Fedoruk, MD
• Leandra Feenstra
• Francisco Javier Felix, PA-C
• Gary Joseph Felix, PA

• Physician Assistant in Colton, CA
• Providers in Colton, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.