Healthcare Provider Details

I. General information

NPI: 1639858822
Provider Name (Legal Business Name): RAND AZOUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2023
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S WELLS RD STE 100
VENTURA CA
93004-1378
US

IV. Provider business mailing address

1040 FLYNN RD
CAMARILLO CA
93012-8705
US

V. Phone/Fax

Practice location:
  • Phone: 805-647-6322
  • Fax: 805-647-7164
Mailing address:
  • Phone: 805-673-3930
  • Fax: 805-659-3217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA210011
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: