Healthcare Provider Details

I. General information

NPI: 1548662182
Provider Name (Legal Business Name): OMAR AZIZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2014
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

852 E DANENBERG DR
EL CENTRO CA
92243-8517
US

IV. Provider business mailing address

852 E DANENBERG DR
EL CENTRO CA
92243-8517
US

V. Phone/Fax

Practice location:
  • Phone: 760-352-2257
  • Fax:
Mailing address:
  • Phone: 760-352-2257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberA182695
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: