Provider Demographics
NPI:1083781470
Name:ATAIZA, AZUCENA M (MD)
Entity Type:Individual
Prefix:
First Name:AZUCENA
Middle Name:M
Last Name:ATAIZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7862 FIRESTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-4221
Mailing Address - Country:US
Mailing Address - Phone:562-869-7007
Mailing Address - Fax:562-862-6418
Practice Address - Street 1:7862 FIRESTONE BLVD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-4221
Practice Address - Country:US
Practice Address - Phone:562-869-7007
Practice Address - Fax:562-862-6418
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43034173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA85849Medicare UPIN