Healthcare Provider Details

I. General information

NPI: 1154285401
Provider Name (Legal Business Name): AZALYA DOLPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 N CENTRAL AVE
GLENDALE CA
91203-3526
US

IV. Provider business mailing address

11335 MEDINA CT
EL MONTE CA
91731-2109
US

V. Phone/Fax

Practice location:
  • Phone: 661-360-6300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: