Provider Demographics
NPI:1710455373
Name:AZIZ, SAMIMAH (MS)
Entity Type:Individual
Prefix:MS
First Name:SAMIMAH
Middle Name:
Last Name:AZIZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2441 SHELDON DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-8840
Mailing Address - Country:US
Mailing Address - Phone:678-549-4775
Mailing Address - Fax:
Practice Address - Street 1:1545 WEBSTER ST STE A
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-4917
Practice Address - Country:US
Practice Address - Phone:707-673-2242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5179101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional