Healthcare Provider Details

I. General information

NPI: 1528221983
Provider Name (Legal Business Name): RAYMOND ADLY AZAB
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18436 ROSCOE BLVD
NORTHRIDGE CA
91325-4107
US

IV. Provider business mailing address

18436 ROSCOE BLVD
NORTHRIDGE CA
91325-4107
US

V. Phone/Fax

Practice location:
  • Phone: 818-435-1400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME154637
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberA124719
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: