Provider Demographics
NPI:1366438764
Name:AZIMI, NASSIR A (MD)
Entity type:Individual
Prefix:
First Name:NASSIR
Middle Name:A
Last Name:AZIMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8911 LA MESA BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-9000
Mailing Address - Country:US
Mailing Address - Phone:619-567-7400
Mailing Address - Fax:877-939-9674
Practice Address - Street 1:8911 LA MESA BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-9000
Practice Address - Country:US
Practice Address - Phone:619-567-7400
Practice Address - Fax:877-939-9674
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91478207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI33800Medicare UPIN
CAWA91478AMedicare ID - Type UnspecifiedMEDICARE