Basic Information
| Provider Information | |||||||||
| NPI: | 1508310855 | ||||||||
| 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 | ||||||||
| FaxNumber: | 9093851690 | ||||||||
| 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: | 08/04/2016 | ||||||||
| LastUpdateDate: | 01/06/2020 | ||||||||
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| AuthorizedOfficialLastName: | AZAR | ||||||||
| AuthorizedOfficialFirstName: | EDWARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4155164969 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
| NPICertificationDate: | 01/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP1100X | E5241 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Podiatric |
No ID Information.