Provider Demographics
NPI:1396740627
Name:ALAZIZ, ATIF JAMEEL (MD)
Entity type:Individual
Prefix:DR
First Name:ATIF
Middle Name:JAMEEL
Last Name:ALAZIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18370 BURBANK BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2831
Mailing Address - Country:US
Mailing Address - Phone:818-462-2195
Mailing Address - Fax:818-996-1649
Practice Address - Street 1:18370 BURBANK BLVD
Practice Address - Street 2:STE 201
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2831
Practice Address - Country:US
Practice Address - Phone:818-462-2195
Practice Address - Fax:818-996-1649
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26478207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAYYY40048YOtherBLUE SHIELD OF CALIFORNIA
CA95-3132732OtherBLUE CROSS OF CALIFORNIA
CAWA26478COtherMEDICARE RENDERING NUMBER
CAT0796OtherRAILROAD GROUP NUMBER
CA110061982OtherRAI8LROAD RENDERING NUMBE
CAYYY40048YMedicaid
CAW1077Medicare PIN
CAWA26478COtherMEDICARE RENDERING NUMBER