Provider Demographics
NPI:1902908288
Name:AZIMI, NOOR SABA (MD)
Entity Type:Individual
Prefix:MS
First Name:NOOR
Middle Name:SABA
Last Name:AZIMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:NORA
Other - Middle Name:SABA
Other - Last Name:AZIMI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1300 S ELISEO DR
Mailing Address - Street 2:#203
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2023
Mailing Address - Country:US
Mailing Address - Phone:415-461-3300
Mailing Address - Fax:415-461-3934
Practice Address - Street 1:1300 S ELISEO DR
Practice Address - Street 2:#203
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2023
Practice Address - Country:US
Practice Address - Phone:415-461-3300
Practice Address - Fax:415-461-3934
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA87104208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A871040Medicaid
CA00A871040Medicaid
CA00A871040Medicare ID - Type Unspecified