Provider Demographics
NPI:1194274167
Name:WELIM AZINGE MD INC
Entity type:Organization
Organization Name:WELIM AZINGE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WELIM
Authorized Official - Middle Name:
Authorized Official - Last Name:AZINGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-916-3177
Mailing Address - Street 1:9880 N. MAGNOLIA AVE.
Mailing Address - Street 2:BOX 200
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92040
Mailing Address - Country:US
Mailing Address - Phone:619-916-3177
Mailing Address - Fax:619-757-2328
Practice Address - Street 1:2026 N. IMPERIAL AVE.
Practice Address - Street 2:SUITE D
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243
Practice Address - Country:US
Practice Address - Phone:760-693-5372
Practice Address - Fax:760-693-5375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-30
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA126925207Q00000X, 207QA0401X, 208600000X, 208D00000X, 261QH0100X, 261QM0850X, 261QM1300X, 261QR0405X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Multi-Specialty