MEDICARE: AZITA LOCKE NP

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	363LF0000X	Family Nurse Practitioner	95022389	CA
2	363LF0000X	Family Nurse Practitioner	95131887	CA

General Provider Information

NPI Number	:	1245953686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AZITA LOCKE NP

Provider Business Mailing Address
First Line	:	12855 RUNWAY RD APT 1225
Second Line	:
City	:	PLAYA VISTA
State	:	CA
Zip	:	90094-2667
Country	:	US
Telephone Number	:	805-708-5523
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 S SAN VICENTE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-4653
Country	:	US
Telephone Number	:	310-873-3312
Fax Number	:

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

Provider Enumeration Date	:	09/21/2022
Last Update Date	:	10/30/2025

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Directions to “ AZITA LOCKE NP” Practice Location

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