Provider Demographics
NPI:1659422475
Name:MAHER A. A. AZER, MD, INC.
Entity Type:Organization
Organization Name:MAHER A. A. AZER, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:AZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-426-8881
Mailing Address - Street 1:3810 KATELLA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3302
Mailing Address - Country:US
Mailing Address - Phone:562-426-8881
Mailing Address - Fax:562-594-8085
Practice Address - Street 1:3810 KATELLA AVE
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3302
Practice Address - Country:US
Practice Address - Phone:562-426-8881
Practice Address - Fax:562-594-8085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24828174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0092370Medicaid
CAGR0092370Medicaid
CAZZZ22408ZMedicare ID - Type Unspecified