Provider Demographics
NPI:1831293273
Name:AZIMOV, MICHELLE BETH (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:BETH
Last Name:AZIMOV
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 1:825 N 10TH ST
Mailing Address - Street 2:SANTA PAULA HOSPITAL
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-1309
Mailing Address - Country:US
Mailing Address - Phone:805-933-8600
Mailing Address - Fax:
Practice Address - Street 1:825 N 10TH ST
Practice Address - Street 2:SANTA PAULA HOSPITAL
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-1309
Practice Address - Country:US
Practice Address - Phone:805-933-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65994207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA00659940OtherMEDICAL PROVIDER NUMBER
CAG63891Medicare UPIN
CAWA65994CMedicare PIN