MEDICARE: ISABELLE SAMARAH AZAR PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	11401	AZ

General Provider Information

NPI Number	:	1053127753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISABELLE SAMARAH AZAR PA-C

Provider Business Mailing Address
First Line	:	309 LAKE HAVASU AVE S
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-9309
Country	:	US
Telephone Number	:	928-453-1970
Fax Number	:	855-538-3082

Provider Business Practice Location Address
First Line	:	309 LAKE HAVASU AVE S
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-9309
Country	:	US
Telephone Number	:	928-453-1970
Fax Number	:	855-538-3082

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2024
Last Update Date	:	11/11/2025

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