Provider Demographics
NPI:1114962610
Name:AZAD, HABIB (MD)
Entity Type:Individual
Prefix:
First Name:HABIB
Middle Name:
Last Name:AZAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26522 LA ALAMEDA
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6330
Mailing Address - Country:US
Mailing Address - Phone:949-282-1671
Mailing Address - Fax:949-367-0518
Practice Address - Street 1:26800 CROWN VALLEY PKWY
Practice Address - Street 2:SUITE 250
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6384
Practice Address - Country:US
Practice Address - Phone:949-364-0644
Practice Address - Fax:949-364-1520
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2021-10-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV11824207RN0300X
CAG81238207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G812380Medicaid
CABS865XMedicare PIN
G031150Medicare UPIN
CAWG81238FMedicare PIN
CABS865WMedicare PIN