Provider Demographics
NPI:1265731905
Name:AZAR, DAN RAFAEL (MD MPH)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:RAFAEL
Last Name:AZAR
Suffix:
Gender:M
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N BARRANCA ST
Mailing Address - Street 2:STE 900J
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-1637
Mailing Address - Country:US
Mailing Address - Phone:510-897-1000
Mailing Address - Fax:626-206-0553
Practice Address - Street 1:7011 EAST AVE
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-9610
Practice Address - Country:US
Practice Address - Phone:925-294-2700
Practice Address - Fax:925-294-2392
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG685632083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F33037Medicare UPIN