Basic Information
| Provider Information | |||||||||
| NPI: | 1336647148 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AZILIFE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12865 STARWOOD LN | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921314211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584729294 | ||||||||
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| Practice Location | |||||||||
| Address1: | 435 H ST | ||||||||
| Address2: | |||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919104307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146360342 | ||||||||
| FaxNumber: | 7146360391 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2018 | ||||||||
| LastUpdateDate: | 02/20/2019 | ||||||||
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| AuthorizedOfficialLastName: | ASLIAN | ||||||||
| AuthorizedOfficialFirstName: | AZITA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8584729294 | ||||||||
| IsSoleProprietor: | |||||||||
| 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 | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.