Basic Information
Provider Information
NPI: 1578917621
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AZIZ
FirstName: YASMIN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2830 VICTORY PKWY
Address2:  
City: CINCINNATI
State: OH
PostalCode: 452061785
CountryCode: US
TelephoneNumber: 5132453694
FaxNumber: 5135855511
Practice Location
Address1: 3113 BELLEVUE AVE
Address2:  
City: CINCINNATI
State: OH
PostalCode: 452193158
CountryCode: US
TelephoneNumber: 5134758730
FaxNumber: 5134758033
Other Information
ProviderEnumerationDate: 04/14/2016
LastUpdateDate: 05/03/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/03/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
2084N0400X35139285OHY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology

No ID Information.


Home