MEDICARE: WIDAD ZUHAR AZIZ

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1750063640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WIDAD ZUHAR AZIZ

Provider Business Mailing Address
First Line	:	176 S PIERCE ST
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92020-4144
Country	:	US
Telephone Number	:	858-314-0125
Fax Number	:

Provider Business Practice Location Address
First Line	:	176 S PIERCE ST
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92020-4144
Country	:	US
Telephone Number	:	858-314-0125
Fax Number	:

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

Provider Enumeration Date	:	08/01/2023
Last Update Date	:	08/01/2023

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Directions to “ WIDAD ZUHAR AZIZ ” Practice Location

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