Basic Information
| Provider Information | |||||||||
| NPI: | 1467046771 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AZAR FOOT & ANKLE SPECIALIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9675 MONTE VISTA AVE STE E | ||||||||
| Address2: | |||||||||
| City: | MONTCLAIR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917632213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2135372927 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9675 MONTE VISTA AVE STE E | ||||||||
| Address2: | |||||||||
| City: | MONTCLAIR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917632213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2135372927 | ||||||||
| FaxNumber: | 9093851690 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2021 | ||||||||
| LastUpdateDate: | 02/26/2021 | ||||||||
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| AuthorizedOfficialLastName: | AZAR | ||||||||
| AuthorizedOfficialFirstName: | EDWARD | ||||||||
| AuthorizedOfficialMiddleName: | SHIBLI | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2135372927 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
| NPICertificationDate: | 02/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.