Provider Demographics
NPI:1114516150
Name:ANJUM, AZEEM (RN)
Entity Type:Individual
Prefix:
First Name:AZEEM
Middle Name:
Last Name:ANJUM
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13550 GRAIN LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2852
Mailing Address - Country:US
Mailing Address - Phone:508-523-1981
Mailing Address - Fax:
Practice Address - Street 1:610 EUCLID AVE STE 200
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2951
Practice Address - Country:US
Practice Address - Phone:619-267-9257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95163409163WM0102X
CA95026593363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WM0102XNursing Service ProvidersRegistered NurseMaternal NewbornGroup - Single Specialty