Provider Demographics
NPI:1053127753
Name:AZAR, ISABELLE SAMARAH
Entity type:Individual
Prefix:
First Name:ISABELLE
Middle Name:SAMARAH
Last Name:AZAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3614 ENDURO CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86404-2252
Mailing Address - Country:US
Mailing Address - Phone:928-486-8171
Mailing Address - Fax:
Practice Address - Street 1:3614 ENDURO CIR
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86404-2252
Practice Address - Country:US
Practice Address - Phone:928-486-8171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant