Healthcare Provider Details

I. General information

NPI: 1841848983
Provider Name (Legal Business Name): AZIZA FUNDI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2019
Last Update Date: 09/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 W 29TH AVE
DENVER CO
80211-3803
US

IV. Provider business mailing address

4900 TRENTON ST APT 223
DENVER CO
80238-3949
US

V. Phone/Fax

Practice location:
  • Phone: 303-458-1112
  • Fax:
Mailing address:
  • Phone: 319-640-8912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number0014688
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: