Healthcare Provider Details

I. General information

NPI: 1861015422
Provider Name (Legal Business Name): JENNIFFER AZOLAS CD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2020
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 SKYVIEW ST
PETOSKEY MI
49770-9212
US

IV. Provider business mailing address

250 SKYVIEW ST
PETOSKEY MI
49770-9212
US

V. Phone/Fax

Practice location:
  • Phone: 310-951-5306
  • Fax:
Mailing address:
  • Phone: 310-951-5306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License NumberSBD20110190
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: