Provider Demographics
NPI:1922259787
Name:AZAR, NICOLA FARIS (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLA
Middle Name:FARIS
Last Name:AZAR
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 1:1000 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
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA121880207Q00000X
IL036121756207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212506OtherMEDICARE
IL212506OtherMEDICARE