Provider Demographics
NPI:1720742869
Name:AZAP, ELVIS ASONGANYI
Entity type:Individual
Prefix:
First Name:ELVIS
Middle Name:ASONGANYI
Last Name:AZAP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4156 BEVERLY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-1649
Mailing Address - Country:US
Mailing Address - Phone:216-551-2473
Mailing Address - Fax:
Practice Address - Street 1:4156 BEVERLY HILLS DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-1649
Practice Address - Country:US
Practice Address - Phone:216-551-2473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-25
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Yes251E00000XAgenciesHome Health