Healthcare Provider Details

I. General information

NPI: 1700149663
Provider Name (Legal Business Name): ROBERT ANTHONY AZURIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2012
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4075 TWEEDY BLVD
SOUTH GATE CA
90280-6146
US

IV. Provider business mailing address

4075 TWEEDY BLVD.
SOUTH GATE CA
90280
US

V. Phone/Fax

Practice location:
  • Phone: 323-566-4111
  • Fax:
Mailing address:
  • Phone: 323-566-4111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA132890
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: