Provider Demographics
NPI:1629662945
Name:AZAR FOOT & ANKLE SPECIALIST
Entity Type:Organization
Organization Name:AZAR FOOT & ANKLE SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:SHIBLI
Authorized Official - Last Name:AZAR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:213-537-2927
Mailing Address - Street 1:9675 MONTE VISTA AVE STE D
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2213
Mailing Address - Country:US
Mailing Address - Phone:213-537-2927
Mailing Address - Fax:
Practice Address - Street 1:13925 INDIAN ST
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-5718
Practice Address - Country:US
Practice Address - Phone:213-537-2927
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-26
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric