Provider Demographics
NPI:1568015147
Name:AZADI, HOSSEIN (MD)
Entity type:Individual
Prefix:DR
First Name:HOSSEIN
Middle Name:
Last Name:AZADI
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 1:3 MARCELA DR
Mailing Address - Street 2:
Mailing Address - City:WILLITS
Mailing Address - State:CA
Mailing Address - Zip Code:95490-5769
Mailing Address - Country:US
Mailing Address - Phone:707-459-6115
Mailing Address - Fax:707-456-9314
Practice Address - Street 1:3 MARCELA DR
Practice Address - Street 2:
Practice Address - City:WILLITS
Practice Address - State:CA
Practice Address - Zip Code:95490-5769
Practice Address - Country:US
Practice Address - Phone:707-459-6115
Practice Address - Fax:707-456-9314
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1952342083A0300X
390200000X
FLME161260207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA195234OtherMEDICAL BOARD OF CALIFORNIA
CAA195234OtherMEDICAL BOARD OF CALIFORNIA
NMRS-12345OtherUNMH