Provider Demographics
NPI:1700956331
Name:AZAR, NASER WADIE (MD)
Entity Type:Individual
Prefix:DR
First Name:NASER
Middle Name:WADIE
Last Name:AZAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:702-579-3203
Mailing Address - Fax:702-838-1456
Practice Address - Street 1:2071 COMPTON AVE STE 101
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-7279
Practice Address - Country:US
Practice Address - Phone:951-549-0900
Practice Address - Fax:951-278-8553
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA54778207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG1880Medicare UPIN
CA00A547780Medicare PIN