Healthcare Provider Details

I. General information

NPI: 1649581075
Provider Name (Legal Business Name): NIMA AZARBEHI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1641 E OSBORN RD STE 4
PHOENIX AZ
85016-7146
US

IV. Provider business mailing address

1641 E OSBORN RD STE 4
PHOENIX AZ
85016-7146
US

V. Phone/Fax

Practice location:
  • Phone: 480-630-2886
  • Fax: 480-378-8124
Mailing address:
  • Phone: 480-510-8401
  • Fax: 480-378-8124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberOS19719
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number007890
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS19719
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO161777
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number9061A
License Number StateWY
# 6
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number007890
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: