Provider Demographics
NPI:1326132945
Name:AZURIN, NARCISO (MD)
Entity Type:Individual
Prefix:
First Name:NARCISO
Middle Name:
Last Name:AZURIN
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 1:4075 TWEEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-6146
Mailing Address - Country:US
Mailing Address - Phone:323-566-4111
Mailing Address - Fax:323-563-0439
Practice Address - Street 1:4075 TWEEDY BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-6146
Practice Address - Country:US
Practice Address - Phone:323-566-4111
Practice Address - Fax:323-563-0439
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36302207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A363020Medicaid
CAA36302OtherLICENSE NUMBER
CAA36302OtherLICENSE NUMBER