Basic Information
| Provider Information | |||||||||
| NPI: | 1750989141 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NOOR SABA AZIMI MD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 347226 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 332347226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7866213900 | ||||||||
| FaxNumber: | 7869752608 | ||||||||
| Practice Location | |||||||||
| Address1: | 19845 LAKE CHABOT RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | CASTRO VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945464055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105385500 | ||||||||
| FaxNumber: | 5105385505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2020 | ||||||||
| LastUpdateDate: | 10/16/2020 | ||||||||
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| AuthorizedOfficialLastName: | AZIMI | ||||||||
| AuthorizedOfficialFirstName: | NOOR | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5105385500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 10/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.