Provider Demographics
NPI:1790340784
Name:AIZENBERG, ADIEL M (MD)
Entity Type:Individual
Prefix:DR
First Name:ADIEL
Middle Name:M
Last Name:AIZENBERG
Suffix:
Gender:M
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:PO BOX 245057
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85724-5057
Mailing Address - Country:US
Mailing Address - Phone:956-744-3125
Mailing Address - Fax:
Practice Address - Street 1:1501 N CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724-2707
Practice Address - Country:US
Practice Address - Phone:956-744-3125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT2807207P00000X, 207PT0002X
AZ65525207PT0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PT0002XAllopathic & Osteopathic PhysiciansEmergency MedicineMedical Toxicology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine