Basic Information
| Provider Information | |||||||||
| NPI: | 1295955524 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AZIZEH ASGARI, MD, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16661 VENTURA BLVD | ||||||||
| Address2: | SUITE 309 | ||||||||
| City: | ENCINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914361914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189956046 | ||||||||
| FaxNumber: | 8189955726 | ||||||||
| Practice Location | |||||||||
| Address1: | 1030 S GLENDALE AVE | ||||||||
| Address2: | SUITE 406 | ||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912055612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182410016 | ||||||||
| FaxNumber: | 8182410407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ASGARIPOUR | ||||||||
| AuthorizedOfficialFirstName: | AZIZEH | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8189956046 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | A48989 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 00A489891 | 05 | CA | MEDICAID |