Healthcare Provider Details

I. General information

NPI: 1578917621
Provider Name (Legal Business Name): YASMIN AZIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3113 BELLEVUE AVE
CINCINNATI OH
45219-3158
US

IV. Provider business mailing address

2830 VICTORY PKWY
CINCINNATI OH
45206-1785
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-8730
  • Fax: 513-475-8033
Mailing address:
  • Phone: 513-245-3694
  • Fax: 513-585-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number35139285
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: