Healthcare Provider Details

I. General information

NPI: 1295980431
Provider Name (Legal Business Name): AZITA TAGHAVY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BON AIR RD, MARIN GENERAL HOSPITAL
GREENBRAE CA
94904-2000
US

IV. Provider business mailing address

250 BON AIR RD
GREENBRAE CA
94904-1702
US

V. Phone/Fax

Practice location:
  • Phone: 510-230-3320
  • Fax:
Mailing address:
  • Phone: 510-230-3320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA114414
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA114414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: