=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659479269
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NARCISO M AZURIN MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 03/15/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4075 TWEEDY BLVD
-----------------------------------------------------
City | SOUTH GATE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90280-6146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-566-4111
-----------------------------------------------------
Fax | 323-563-0439
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4075 TWEEDY BLVD
-----------------------------------------------------
City | SOUTH GATE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90280-6146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-566-4111
-----------------------------------------------------
Fax | 323-563-0439
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT PHYSICIAN
-----------------------------------------------------
Name | NARCISO M AZURIN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 323-566-4111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | A36302
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------