Provider Demographics
NPI:1205406477
Name:AZITA TAGHAVY - A PROFESSIONAL CORP
Entity type:Organization
Organization Name:AZITA TAGHAVY - A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AZITA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAGHAVY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-924-5010
Mailing Address - Street 1:21 TAMAL VISTA BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1122
Mailing Address - Country:US
Mailing Address - Phone:415-924-5010
Mailing Address - Fax:415-924-5210
Practice Address - Street 1:21 TAMAL VISTA BLVD STE 110
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1122
Practice Address - Country:US
Practice Address - Phone:415-924-5010
Practice Address - Fax:415-924-5210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-29
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty