Provider Demographics
NPI:1871248401
Name:AZAR MEDICAL
Entity Type:Organization
Organization Name:AZAR MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:AZAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-667-7473
Mailing Address - Street 1:1000 NEWBURY RD STE 265
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91320-6444
Mailing Address - Country:US
Mailing Address - Phone:818-667-7473
Mailing Address - Fax:818-914-4230
Practice Address - Street 1:1000 NEWBURY RD STE 265
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91320-6444
Practice Address - Country:US
Practice Address - Phone:818-667-7473
Practice Address - Fax:818-914-4230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty