Provider Demographics
NPI:1891864070
Name:AZER, NAGWA L (MD)
Entity Type:Individual
Prefix:
First Name:NAGWA
Middle Name:L
Last Name:AZER
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 1:15852 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744
Mailing Address - Country:US
Mailing Address - Phone:626-968-0542
Mailing Address - Fax:626-968-6342
Practice Address - Street 1:15852 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744
Practice Address - Country:US
Practice Address - Phone:626-968-0542
Practice Address - Fax:626-968-6342
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41880207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A418800Medicaid
CAW11737Medicare ID - Type Unspecified
E90972Medicare UPIN