Provider Demographics
NPI:1053582171
Name:AZURIN, ELEANOR V (MD)
Entity type:Individual
Prefix:DR
First Name:ELEANOR
Middle Name:V
Last Name:AZURIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3045 E FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-5837
Mailing Address - Country:US
Mailing Address - Phone:323-587-7771
Mailing Address - Fax:323-587-8310
Practice Address - Street 1:3045 E FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-5837
Practice Address - Country:US
Practice Address - Phone:323-587-7771
Practice Address - Fax:323-587-8310
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66742207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A667420Medicaid
CAA66742Medicare PIN