Provider Demographics
NPI:1689182982
Name:AZAMI, HOMA (MPT, PT)
Entity Type:Individual
Prefix:
First Name:HOMA
Middle Name:
Last Name:AZAMI
Suffix:
Gender:F
Credentials:MPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 SPARROW HILL LN
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-6014
Mailing Address - Country:US
Mailing Address - Phone:714-904-5321
Mailing Address - Fax:
Practice Address - Street 1:12 SPARROW HILL LN
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-6014
Practice Address - Country:US
Practice Address - Phone:714-904-5321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-21
Last Update Date:2018-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT256432081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine