Provider Demographics
NPI:1003150657
Name:AZIM U. AZHAND, M.D. PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:AZIM U. AZHAND, M.D. PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AZIM
Authorized Official - Middle Name:U
Authorized Official - Last Name:AZHAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-695-4333
Mailing Address - Street 1:27450 YNEZ RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-4671
Mailing Address - Country:US
Mailing Address - Phone:951-695-4333
Mailing Address - Fax:951-695-4828
Practice Address - Street 1:27450 YNEZ RD
Practice Address - Street 2:SUITE 108
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-4671
Practice Address - Country:US
Practice Address - Phone:951-695-4333
Practice Address - Fax:951-695-4828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49621261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A4962100Medicaid