Healthcare Provider Details

I. General information

NPI: 1942813498
Provider Name (Legal Business Name): AZAR ALI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date: 11/08/2022
Reactivation Date: 11/16/2022

III. Provider practice location address

260 BROOKLYN BASIN WAY UNIT 662
OAKLAND CA
94606-5280
US

IV. Provider business mailing address

260 BROOKLYN BASIN WAY UNIT 662
OAKLAND CA
94606-5280
US

V. Phone/Fax

Practice location:
  • Phone: 510-646-0647
  • Fax:
Mailing address:
  • Phone: 510-646-0647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number112623
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number112623
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number138316
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number112623
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC61604892
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: