Healthcare Provider Details

I. General information

NPI: 1558567248
Provider Name (Legal Business Name): ALI M AZIZI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16661 VENTURE BLVD #708
ENCINO CA
91436
US

IV. Provider business mailing address

16661 VENTURE BLVD #708
ENCINO CA
91436
US

V. Phone/Fax

Practice location:
  • Phone: 818-501-7474
  • Fax: 818-501-8410
Mailing address:
  • Phone: 818-501-7474
  • Fax: 818-501-8410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberA045136
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA045136
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: