Healthcare Provider Details

I. General information

NPI: 1831293273
Provider Name (Legal Business Name): MICHELLE BETH AZIMOV M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 N 10TH ST SANTA PAULA HOSPITAL
SANTA PAULA CA
93060-1309
US

IV. Provider business mailing address

825 N 10TH ST SANTA PAULA HOSPITAL
SANTA PAULA CA
93060-1309
US

V. Phone/Fax

Practice location:
  • Phone: 805-933-8600
  • Fax:
Mailing address:
  • Phone: 805-933-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA65994
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: