Basic Information
| Provider Information | |||||||||
| NPI: | 1821537986 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AZARAN | ||||||||
| FirstName: | MARINE | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16161 VENTURA BLVD | ||||||||
| Address2: | STE C564 | ||||||||
| City: | ENCINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914362522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189070952 | ||||||||
| FaxNumber: | 8189909449 | ||||||||
| Practice Location | |||||||||
| Address1: | 4940 VAN NUYS BLVD | ||||||||
| Address2: | STE 301 | ||||||||
| City: | SHERMAN OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914031700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189070952 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2017 | ||||||||
| LastUpdateDate: | 02/21/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT 291406 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.