Healthcare Provider Details

I. General information

NPI: 1336647148
Provider Name (Legal Business Name): AZILIFE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2018
Last Update Date: 02/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 H ST
CHULA VISTA CA
91910-4307
US

IV. Provider business mailing address

12865 STARWOOD LN
SAN DIEGO CA
92131-4211
US

V. Phone/Fax

Practice location:
  • Phone: 714-636-0342
  • Fax: 714-636-0391
Mailing address:
  • Phone: 858-472-9294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AZITA ASLIAN
Title or Position: PRESIDENT
Credential: MD
Phone: 858-472-9294