| Azita Taghavy - A Professional Corp | |
|
21 Tamal Vista Blvd Ste 110 Corte Madera CA 94925-1122 | |
| (415) 924-5010 | |
| (415) 924-5210 |
| Full Name | Azita Taghavy - A Professional Corp |
|---|---|
| Speciality | Internal Medicine |
| Location | 21 Tamal Vista Blvd Ste 110, Corte Madera, California |
| Authorized Official Name and Position | Azita Taghavy (PRESIDENT) |
| Authorized Official Contact | 4159245010 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Azita Taghavy - A Professional Corp 21 Tamal Vista Blvd Ste 110 Corte Madera CA 94925-1122 Ph: (415) 924-5010 | Azita Taghavy - A Professional Corp 21 Tamal Vista Blvd Ste 110 Corte Madera CA 94925-1122 Ph: (415) 924-5010 |
| NPI Number | 1205406477 |
|---|---|
| Provider Enumeration Date | 06/29/2021 |
| Last Update Date | 07/22/2021 |
| Medicare PECOS PAC ID | 5698172187 |
|---|---|
| Medicare Enrollment ID | O20210927001403 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205406477 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Azita Taghavy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1295980431 PECOS PAC ID: 1850560236 Enrollment ID: I20110802000375 |
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