MEDICARE: AIZ INC

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	208600000X	Surgery Physician
2	302F00000X	Exclusive Provider Organization

General Provider Information

NPI Number	:	1629335492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AIZ INC

Provider Business Mailing Address
First Line	:	24462 KINGS VW
Second Line	:
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92677-7800
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	319 S BRAND BLVD
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204-1701
Country	:	US
Telephone Number	:	818-240-0006
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	ALEXANDER I ZAMANIAN
Credential	:
Telephone Number	:	818-240-0006

Provider Enumeration Date	:	04/18/2012
Last Update Date	:	04/18/2012

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Directions to “AIZ INC ” Practice Location

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