Provider Demographics
NPI:1538278270
Name:ELEANOR V AZURIN MD INC
Entity type:Organization
Organization Name:ELEANOR V AZURIN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ELEANOR
Authorized Official - Middle Name:V
Authorized Official - Last Name:AZURIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-585-7320
Mailing Address - Street 1:7700 PACIFIC BLVD
Mailing Address - Street 2:
Mailing Address - City:WALNUT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-6302
Mailing Address - Country:US
Mailing Address - Phone:323-585-7320
Mailing Address - Fax:323-585-7199
Practice Address - Street 1:7700 PACIFIC BLVD
Practice Address - Street 2:
Practice Address - City:WALNUT PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-6302
Practice Address - Country:US
Practice Address - Phone:323-585-7320
Practice Address - Fax:323-585-7199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66742207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A667420Medicaid
A66742Medicare UPIN
CAA66742Medicare ID - Type Unspecified