Provider Demographics
NPI:1679705735
Name:AZIZ, KAJALLA I
Entity type:Individual
Prefix:MR
First Name:KAJALLA
Middle Name:I
Last Name:AZIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 LOMA ALTA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030
Mailing Address - Country:US
Mailing Address - Phone:831-449-7974
Mailing Address - Fax:831-449-1993
Practice Address - Street 1:499 LOMA ALTA AVE
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030
Practice Address - Country:US
Practice Address - Phone:831-794-2777
Practice Address - Fax:831-794-2777
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health