Healthcare Provider Details

I. General information

NPI: 1508862566
Provider Name (Legal Business Name): LEYLA MOHASSESSY AZMOUN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 W FIR AVE
CLOVIS CA
93611-0220
US

IV. Provider business mailing address

231 W FIR AVE
CLOVIS CA
93611-0220
US

V. Phone/Fax

Practice location:
  • Phone: 559-297-0300
  • Fax: 559-323-5461
Mailing address:
  • Phone: 559-297-0300
  • Fax: 559-323-5461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberG84984
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: