1114962610 NPI number — HABIB AZAD M.D.

Table of content: HABIB AZAD M.D. (NPI 1114962610)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114962610 NPI number — HABIB AZAD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AZAD
Provider First Name:
HABIB
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114962610
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26522 LA ALAMEDA
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
MISSION VIEJO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92691-6330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-282-1671
Provider Business Mailing Address Fax Number:
949-367-0518

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26800 CROWN VALLEY PKWY
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
MISSION VIEJO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92691-6384
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-364-0644
Provider Business Practice Location Address Fax Number:
949-364-1520
Provider Enumeration Date:
06/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  11824 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X , with the licence number: G81238 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00G812380 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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