Provider Demographics
NPI:1437171857
Name:GRIFFIN, AZITA
Entity Type:Individual
Prefix:
First Name:AZITA
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1269 POMONA RD STE 111
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-7158
Mailing Address - Country:US
Mailing Address - Phone:949-939-4981
Mailing Address - Fax:866-620-6665
Practice Address - Street 1:1269 POMONA RD STE 111
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-7158
Practice Address - Country:US
Practice Address - Phone:949-939-4981
Practice Address - Fax:866-620-6665
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29811343900000X
CA900897560343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA29811OtherTCP ( PUBLIC UUILITIES COMMISSION )