Healthcare Provider Details

I. General information

NPI: 1609196930
Provider Name (Legal Business Name): DAVID SHERIF AZER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5199 E PACIFIC COAST HWY STE 302
LONG BEACH CA
90804-7107
US

IV. Provider business mailing address

5199 E PACIFIC COAST HWY STE 302
LONG BEACH CA
90804-7107
US

V. Phone/Fax

Practice location:
  • Phone: 818-321-3332
  • Fax:
Mailing address:
  • Phone: 818-321-3332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number20A10374
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: