Healthcare Provider Details

I. General information

NPI: 1568398345
Provider Name (Legal Business Name): TAMARA AZOULAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8861 VILLA LA JOLLA DR # 13052
LA JOLLA CA
92037-1918
US

IV. Provider business mailing address

8861 VILLA LA JOLLA DR # 13052
LA JOLLA CA
92037-1918
US

V. Phone/Fax

Practice location:
  • Phone: 858-353-4401
  • Fax: 858-353-4401
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: