Provider Demographics
NPI:1437864014
Name:AZAM MD PC
Entity Type:Organization
Organization Name:AZAM MD PC
Other - Org Name:DAYDREAM MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/CMO
Authorized Official - Prefix:
Authorized Official - First Name:ARSALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AZAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-526-2099
Mailing Address - Street 1:4860 MUIR AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-2102
Mailing Address - Country:US
Mailing Address - Phone:216-526-2099
Mailing Address - Fax:
Practice Address - Street 1:3455 INGRAHAM ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-6713
Practice Address - Country:US
Practice Address - Phone:619-937-2055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-18
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA161461OtherMEDICAL BOARD OF CALIFORNIA
CA50842OtherBOARD OF BEHAVIORAL SCIENCE
CA50842OtherBOARD OF BEHAVIORAL SCIENCE
CA86415OtherBOARD OF BEHAVIORAL SCIENCE
CA103479OtherBOARD OF BEHAVIORAL SCIENCE
CA86291OtherBOARD OF BEHAVIORAL SCIENCE
CA161461OtherMEDICAL BOARD OF CALIFORNIA
CA29110OtherCALIFORNIA BOARD OF PSYCHOLOGY