Healthcare Provider Details

I. General information

NPI: 1154593929
Provider Name (Legal Business Name): AYAT AZADIRAD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7232 VAN NUYS BLVD SUITE 201
VAN NUYS CA
91405-2231
US

IV. Provider business mailing address

7232 VAN NUYS BLVD SUITE 201
VAN NUYS CA
91405-2231
US

V. Phone/Fax

Practice location:
  • Phone: 818-373-4999
  • Fax: 818-373-4998
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA95715
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: