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General NPI Number Information
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NPI Number | 1770612798
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Entity Type | Organization
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Legal Business Name | JAY M AZLING APDC
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 12622 E SOUTH STREET
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City | CERRITOS
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State | CA
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Zip | 90703
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Country | US
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Telephone | 562-865-0517
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Fax | 562-865-9697
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Provider Business Mailing Address
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Address Line | 12622 E SOUTH STREET
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City | CERRITOS
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State | CA
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Zip | 90703
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Country | US
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Telephone | 562-865-0517
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Fax | 562-865-9697
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MS. CARLA ANNE AZLING
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Credential |
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Telephone | 714-814-8587
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DJ036221
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License Number State | CA
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