Provider Demographics
NPI:1841368461
Name:AZIZI, FRAIDON FREY (MD)
Entity type:Individual
Prefix:DR
First Name:FRAIDON
Middle Name:FREY
Last Name:AZIZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4718 CLUB VIEW DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-4350
Mailing Address - Country:US
Mailing Address - Phone:805-496-6877
Mailing Address - Fax:
Practice Address - Street 1:2220 LYNN RD STE 103
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-8016
Practice Address - Country:US
Practice Address - Phone:805-373-1182
Practice Address - Fax:805-373-1184
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG82340207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG82340OtherLICENSE
CABA4898928OtherDEA
CAG49693Medicare UPIN
CAWG82340AMedicare PIN