Provider Demographics
NPI:1285686220
Name:AZER, BERNARD M (DO)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:M
Last Name:AZER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 KATELLA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3302
Mailing Address - Country:US
Mailing Address - Phone:562-426-8881
Mailing Address - Fax:562-594-8085
Practice Address - Street 1:3810 KATELLA AVE
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3302
Practice Address - Country:US
Practice Address - Phone:562-426-8881
Practice Address - Fax:562-594-8085
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7817174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0092370OtherMEDICAL GRP #
CAW20A7817AOtherSOUTHERN MEDICARE
CAW1985OtherSOUTHERN MEDICARE GRP #
CA00AX78170OtherNORTHERN MEDICARE/MEDICAL
CAZZZ22408ZOtherNORTHERN MEDICARE GRP #
CA00AX78170OtherNORTHERN MEDICARE/MEDICAL