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General NPI Number Information
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NPI Number | 1518664879
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Entity Type | Individual
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Provider Name | BASSAM AZIZ FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 02/07/2023
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Last Update Date | 02/07/2023
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Provider Practice Location Address
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Address Line | 1350 W COVINA BLVD
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City | SAN DIMAS
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State | CA
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Zip | 91773-3245
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Country | US
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Telephone | 310-592-7149
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Fax |
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Provider Business Mailing Address
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Address Line | 628 E ALLEN AVE
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City | SAN DIMAS
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State | CA
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Zip | 91773-1525
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Country | US
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Telephone | 310-592-7149
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP95023263
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License Number State | CA
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