Provider Demographics
NPI:1003681396
Name:AZAM MD & MCJUNKIN PROF CORP
Entity Type:Organization
Organization Name:AZAM MD & MCJUNKIN PROF CORP
Other - Org Name:DAYDREAM MD INTEGRATIVE HEALTH & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:CAROLYN
Authorized Official - Last Name:MCJUNKIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:619-987-0158
Mailing Address - Street 1:4860 MUIR AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-2102
Mailing Address - Country:US
Mailing Address - Phone:619-937-2055
Mailing Address - Fax:
Practice Address - Street 1:3455 INGRAHAM ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-6713
Practice Address - Country:US
Practice Address - Phone:619-937-2055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-16
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty