Provider Demographics
NPI:1376119008
Name:AZEN HEALTH INC
Entity Type:Organization
Organization Name:AZEN HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEMNITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:415-996-4793
Mailing Address - Street 1:1005 NORTHGATE DR # 168
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-2500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:508-213-3565
Practice Address - Street 1:57 VALLEJO WAY
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2337
Practice Address - Country:US
Practice Address - Phone:415-996-4793
Practice Address - Fax:508-213-3565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty