Individual
MARY AZAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
160 E VIRGINIA ST STE 100, SAN JOSE, CA 95112-5865
(408) 694-8463
Mailing address
1724 SAMSON CT, SAN JOSE, CA 95124-4600
(408) 694-8463
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
480700
CA
363LF0000X
Family Nurse Practitioner
95005580
CA
Other
Enumeration date
07/11/2016
Last updated
02/05/2019
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