Healthcare Provider Details

I. General information

NPI: 1659479269
Provider Name (Legal Business Name): NARCISO M AZURIN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 03/15/2010
Certification Date:
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
90280-6146
US

V. Phone/Fax

Practice location:
  • Phone: 323-566-4111
  • Fax: 323-563-0439
Mailing address:
  • Phone: 323-566-4111
  • Fax: 323-563-0439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA36302
License Number StateCA

VIII. Authorized Official

Name: NARCISO M AZURIN
Title or Position: PRESIDENT PHYSICIAN
Credential: MD
Phone: 323-566-4111