Provider Demographics
NPI:1669632154
Name:AZMA, AZIN (MD)
Entity Type:Individual
Prefix:
First Name:AZIN
Middle Name:
Last Name:AZMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 VILLAGE CENTER CIR STE 3-717
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-6299
Mailing Address - Country:US
Mailing Address - Phone:702-432-2233
Mailing Address - Fax:702-800-5456
Practice Address - Street 1:2020 WELLNESS WAY STE 300
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4145
Practice Address - Country:US
Practice Address - Phone:702-432-2233
Practice Address - Fax:702-800-5456
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP01305207R00000X
NV147202084N0600X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCS21076OtherNEVADA STATE BOARD OF PHARMACY - CONTROLLED SUBSTANCE (CS)
NV100534077Medicaid
NV12561707OtherCAQH
NV12561707OtherCAQH