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General NPI Number Information
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NPI Number | 1043849490
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Entity Type | Individual
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Provider Name | PETER JOSEPH AZZAM MD
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Gender | Male
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Dates
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Enumeration Date | 04/07/2020
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Last Update Date | 09/24/2025
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Provider Practice Location Address
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Address Line | 24012 CALLE DE LA PLATA STE 350
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-7624
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Country | US
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Telephone | 949-557-0390
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Fax |
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Provider Business Mailing Address
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Address Line | 24012 CALLE DE LA PLATA
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-3621
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Country | US
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Telephone | 949-557-0390
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Fax | 949-557-0391
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A180837
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License Number State | CA
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