Healthcare Provider Details

I. General information

NPI: 1083781470
Provider Name (Legal Business Name): AZUCENA M ATAIZA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7862 FIRESTONE BLVD
DOWNEY CA
90241-4221
US

IV. Provider business mailing address

7862 FIRESTONE BLVD
DOWNEY CA
90241-4221
US

V. Phone/Fax

Practice location:
  • Phone: 562-869-7007
  • Fax: 562-862-6418
Mailing address:
  • Phone: 562-869-7007
  • Fax: 562-862-6418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberA43034
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: