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General NPI Number Information
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NPI Number | 1376119008
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Entity Type | Organization
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Legal Business Name | AZEN HEALTH INC
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Dates
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Enumeration Date | 06/02/2021
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Last Update Date | 06/02/2021
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Provider Practice Location Address
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Address Line | 57 VALLEJO WAY
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City | SAN RAFAEL
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State | CA
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Zip | 94903-2337
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Country | US
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Telephone | 415-996-4793
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Fax | 508-213-3565
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Provider Business Mailing Address
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Address Line | 1005 NORTHGATE DR # 168
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City | SAN RAFAEL
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State | CA
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Zip | 94903-2500
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Country | US
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Telephone |
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Fax | 508-213-3565
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Authorized Official
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Title or Position | PRESIDENT
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Name | THERESA KEMNITZ
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Credential | DO
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Telephone | 415-996-4793
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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