Provider Demographics
NPI:1710412499
Name:AZMI, HALA MARIE (PA-C, MMS)
Entity Type:Individual
Prefix:MRS
First Name:HALA
Middle Name:MARIE
Last Name:AZMI
Suffix:
Gender:F
Credentials:PA-C, MMS
Other - Prefix:MISS
Other - First Name:HALA
Other - Middle Name:MARIE
Other - Last Name:GHALY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:9961 SIERRA AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-6720
Mailing Address - Country:US
Mailing Address - Phone:909-427-5000
Mailing Address - Fax:
Practice Address - Street 1:301 W REDLANDS BLVD
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4633
Practice Address - Country:US
Practice Address - Phone:909-335-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-01
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54402363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical