Provider Demographics
NPI:1326721085
Name:AZEM, ASHKAN
Entity Type:Individual
Prefix:
First Name:ASHKAN
Middle Name:
Last Name:AZEM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3823 SAGE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-3509
Mailing Address - Country:US
Mailing Address - Phone:121-034-6730
Mailing Address - Fax:
Practice Address - Street 1:3823 SAGE RIDGE DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-3509
Practice Address - Country:US
Practice Address - Phone:210-346-7096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)