Provider Demographics
NPI:1558605493
Name:AZIMI, FAZILAT
Entity Type:Individual
Prefix:
First Name:FAZILAT
Middle Name:
Last Name:AZIMI
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 1:22647 VENTURA BLVD # 542
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1416
Mailing Address - Country:US
Mailing Address - Phone:818-498-6376
Mailing Address - Fax:
Practice Address - Street 1:420 S BEVERLY DR STE 100
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4410
Practice Address - Country:US
Practice Address - Phone:310-400-6585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 51157106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC 51157OtherMARRIAGE AND FAMILY THERAPIST