Provider Demographics
NPI:1659479269
Name:NARCISO M AZURIN MD INC
Entity type:Organization
Organization Name:NARCISO M AZURIN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NARCISO
Authorized Official - Middle Name:M
Authorized Official - Last Name:AZURIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-566-4111
Mailing Address - Street 1:4075 TWEEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-6146
Mailing Address - Country:US
Mailing Address - Phone:323-566-4111
Mailing Address - Fax:323-563-0439
Practice Address - Street 1:4075 TWEEDY BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-6146
Practice Address - Country:US
Practice Address - Phone:323-566-4111
Practice Address - Fax:323-563-0439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
213E00000X
CAA36302207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0016090Medicaid
CAW032Medicare PIN
CAGR0016090Medicaid