Basic Information
| Provider Information | |||||||||
| NPI: | 1851584312 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AZAD | ||||||||
| FirstName: | RAANA | ||||||||
| MiddleName: | FRYER | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 726 SEABRIGHT LN | ||||||||
| Address2: | |||||||||
| City: | SOLANA BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920751271 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8587558159 | ||||||||
| FaxNumber: | 8587552522 | ||||||||
| Practice Location | |||||||||
| Address1: | 2403 SAN MATEO BLVD NE | ||||||||
| Address2: | SUITE S-14 | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871104058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058301871 | ||||||||
| FaxNumber: | 5058300040 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2007 | ||||||||
| LastUpdateDate: | 08/19/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | NA | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.