Provider Demographics
NPI:1225525710
Name:CHANGO AZANZA, JUAN JOSE (MD)
Entity Type:Individual
Prefix:
First Name:JUAN JOSE
Middle Name:
Last Name:CHANGO AZANZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2905
Mailing Address - Country:US
Mailing Address - Phone:617-638-7503
Mailing Address - Fax:617-414-1831
Practice Address - Street 1:820 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2905
Practice Address - Country:US
Practice Address - Phone:617-638-7503
Practice Address - Fax:617-414-1831
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2022-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program