Healthcare Provider Details

I. General information

NPI: 1528636891
Provider Name (Legal Business Name): MARIYA SERGEYEVNA AZAROV FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6939 SUNRISE BLVD STE 106
CITRUS HEIGHTS CA
95610-3153
US

IV. Provider business mailing address

6939 SUNRISE BLVD STE 106
CITRUS HEIGHTS CA
95610-3153
US

V. Phone/Fax

Practice location:
  • Phone: 916-587-8000
  • Fax: 916-480-8400
Mailing address:
  • Phone: 916-587-8000
  • Fax: 916-480-8400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95017414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: