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General NPI Number Information
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NPI Number | 1760837538
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Entity Type | Organization
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Legal Business Name | NICOLA AZAR MD, INC
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Dates
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Enumeration Date | 04/29/2016
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Last Update Date | 04/29/2016
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Provider Practice Location Address
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Address Line | 866 N VERMONT AVE SUITE 3
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City | LOS ANGELES
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State | CA
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Zip | 90029-3587
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Country | US
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Telephone | 323-661-0105
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Fax |
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Provider Business Mailing Address
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Address Line | 866 N VERMONT AVE SUITE 3
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City | LOS ANGELES
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State | CA
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Zip | 90029-3587
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Country | US
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Telephone | 323-661-0105
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NICOLA AZAR
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Credential | MD
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Telephone | 323-661-0105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 3886023
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License Number State | CA
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