Healthcare Provider Details

I. General information

NPI: 1982984167
Provider Name (Legal Business Name): AMELIA ALEJANDRA AZZAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2011
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 S POPLAR ST
SANTA ANA CA
92704-4321
US

IV. Provider business mailing address

1801 S POPLAR ST
SANTA ANA CA
92704-4321
US

V. Phone/Fax

Practice location:
  • Phone: 714-433-3481
  • Fax:
Mailing address:
  • Phone: 714-433-3481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number75284
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: