Healthcare Provider Details

I. General information

NPI: 1194274167
Provider Name (Legal Business Name): WELIM AZINGE MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2016
Last Update Date: 03/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2026 N. IMPERIAL AVE. SUITE D
EL CENTRO CA
92243
US

IV. Provider business mailing address

9880 N. MAGNOLIA AVE. BOX 200
SANTEE CA
92040
US

V. Phone/Fax

Practice location:
  • Phone: 760-693-5372
  • Fax: 760-693-5375
Mailing address:
  • Phone: 619-916-3177
  • Fax: 619-757-2328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberA126925
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA126925
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA126925
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberA126925
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberA126925
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberA126925
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberA126925
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberA126925
License Number StateCA
# 9
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA126925
License Number StateCA

VIII. Authorized Official

Name: DR. WELIM AZINGE
Title or Position: PRESIDENT
Credential: MD
Phone: 619-916-3177