Provider Demographics
NPI:1922174267
Name:AZAMOV, ALISHERHON (MD)
Entity Type:Individual
Prefix:DR
First Name:ALISHERHON
Middle Name:
Last Name:AZAMOV
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 1:7514 GIRARD AVE STE 1124
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-5149
Mailing Address - Country:US
Mailing Address - Phone:619-955-8494
Mailing Address - Fax:619-243-7317
Practice Address - Street 1:4653 CARMEL MOUNTAIN RD STE 308-201
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-6650
Practice Address - Country:US
Practice Address - Phone:619-955-8494
Practice Address - Fax:619-243-7317
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246Z00000X
CACA7611102084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Multi-Specialty
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Multi-Specialty