Provider Demographics
NPI:1699906032
Name:SHAMANI, AZAM (MD)
Entity type:Individual
Prefix:DR
First Name:AZAM
Middle Name:
Last Name:SHAMANI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:5555 RESERVOIR DR
Mailing Address - Street 2:STE 312
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-5134
Mailing Address - Country:US
Mailing Address - Phone:619-639-7285
Mailing Address - Fax:619-639-7286
Practice Address - Street 1:5555 RESERVOIR DR
Practice Address - Street 2:STE 312
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5134
Practice Address - Country:US
Practice Address - Phone:619-639-7285
Practice Address - Fax:619-639-7286
Is Sole Proprietor?:No
Enumeration Date:2009-08-03
Last Update Date:2015-06-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA109713207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA109713OtherLICENSE NUMBER