| Azen Health Inc | |
|
57 Vallejo Way San Rafael CA 94903-2337 | |
| (415) 996-4793 | |
| (508) 213-3565 |
| Full Name | Azen Health Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 57 Vallejo Way, San Rafael, California |
| Authorized Official Name and Position | Theresa Kemnitz (PRESIDENT) |
| Authorized Official Contact | 4159964793 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Azen Health Inc 1005 Northgate Dr # 168 San Rafael CA 94903-2500 Ph: () - | Azen Health Inc 57 Vallejo Way San Rafael CA 94903-2337 Ph: (415) 996-4793 |
| NPI Number | 1376119008 |
|---|---|
| Provider Enumeration Date | 06/02/2021 |
| Last Update Date | 06/02/2021 |
| Medicare PECOS PAC ID | 3072903822 |
|---|---|
| Medicare Enrollment ID | O20211209001405 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376119008 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Theresa Kemnitz |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1033419338 PECOS PAC ID: 7012184146 Enrollment ID: I20120112000690 |
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