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TAREK EZZEDDINE MD INC
NPI 1548701287
General Practice in Rancho Cucamonga, CA

Active since March 14, 2017CLIA 05D2160329 · Waiver
10841 WHITE OAK AVE STE 103, RANCHO CUCAMONGA, CA 91730(909) 360-4722(909) 360-4721 Get Directions Write a Review

NPPES record last updated: January 6, 2020. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jan 6, 2020, Jul 11, 2018, Jun 28, 2018 and 1 more (4 updates tracked since 2017).

About Tarek Ezzeddine Md Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TAREK EZZEDDINE MD INC (NPI 1548701287) is a healthcare organization registered as a general practice in Rancho Cucamonga, California and active in the NPI registry since March 2017. The organization holds a CLIA Waiver certificate valid through January 7, 2027 and lists Tarek Ezzeddine, President, as its authorized official.

NPPES Registry Identity

NPI1548701287
Entity TypeOrganization
Primary Taxonomy208D00000X
Legal Business NameTAREK EZZEDDINE MD INC
Location Address10841 WHITE OAK AVE STE 103Rancho Cucamonga, CA 91730-3817
Mailing Address10841 White Oak Ave Ste 103Rancho Cucamonga, CA 91730-3817 · (909) 360-4722
Phone(909) 360-4722
Fax(909) 360-4721
Organization SubpartNo
Authorized OfficialTarek EzzeddinePresident · (810) 814-5600
Enumeration DateMarch 14, 2017
Last NPPES UpdateJanuary 6, 20204 updates tracked since enumeration
✔ NPI 1548701287 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
License✔ Licensed in CA · C133690
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
10841 WHITE OAK AVE STE 103, Rancho Cucamonga, CA 91730
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Tarek Ezzeddine Md Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Tarek Ezzeddine MD Inc, which bills Medicare for the services this clinician delivers.

Clinician (1)

Tarek Ezzeddine, MD
Internal Medicine
NPI 1740471879
8250 WHITE OAK AVE STE 106
Rancho Cucamonga, CA 91730
(909) 360-4722
✔ PECOS✔ Accepts Medicare0.1 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D2160329

Tarek Ezzeddine MD Inc · Rancho Cucamonga, CA
Active · expires Jan 7, 2027
CLIA Number05D2160329
Laboratory TypePhysician Office
Certificate Effective DateJanuary 8, 2025
Certificate Expiration DateJanuary 7, 2027
Laboratory DirectorEzzeddine Tarek
Laboratory Phone(909) 360-4722
Laboratory LocationTarek Ezzeddine MD Inc8250 White Oak Ave #106, Rancho Cucamonga, CA 91730
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Tarek Ezzeddine MD Inc's NPI number?

The NPI number for Tarek Ezzeddine MD Inc is 1548701287. It was assigned to this organization in the NPPES registry on March 14, 2017.

Where is Tarek Ezzeddine MD Inc located?

Tarek Ezzeddine MD Inc is located at 10841 White Oak Ave Ste 103, Rancho Cucamonga, CA 91730. The listed phone number is (909) 360-4722.

What is Tarek Ezzeddine MD Inc's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Is Tarek Ezzeddine MD Inc enrolled in Medicare?

Yes. Tarek Ezzeddine MD Inc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Tarek Ezzeddine MD Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Internal Medicine) reassigns their Medicare billing to Tarek Ezzeddine MD Inc. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Tarek Ezzeddine MD Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D2160329) is associated with this NPI, valid through January 7, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Tarek Ezzeddine MD Inc was last updated on January 6, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.