Healthcare Provider Details

I. General information

NPI: 1407441298
Provider Name (Legal Business Name): MARINA AZER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3695 ALAMO ST
SIMI VALLEY CA
93063-2188
US

IV. Provider business mailing address

17821 LASSEN ST APT 223
NORTHRIDGE CA
91325-4711
US

V. Phone/Fax

Practice location:
  • Phone: 805-306-1636
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number75917
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: