Healthcare Provider Details

I. General information

NPI: 1982087763
Provider Name (Legal Business Name): ROBERT AZURIN, M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 07/10/2015
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: 877-255-1761
Mailing address:
  • Phone: 323-566-4111
  • Fax: 877-255-1761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberA132890
License Number StateCA

VIII. Authorized Official

Name: DR. ROBERT ANTHONY AZURIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 562-644-4179