Mazimo Azucena Afh

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

License

751038 Issued in WA

Legal business name

MAZIMO AZUCENA AFH

Practice address

10522 19TH PL W
Everett, WA 98204-3663

Phone

(425) 322-5328

Fax

(425) 322-5328

NPI assigned

Oct 16, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Maximo Dimaunahan Azucena

Title

Provider

Phone

(425) 322-5328

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1413417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413417600000",
    "number": "1205230489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10522 19TH PL W",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982043663",
            "telephone_number": "425-322-5328",
            "fax_number": "425-322-5328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10522 19TH PL W",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982043663",
            "telephone_number": "425-322-5328",
            "fax_number": "425-322-5328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAZIMO AZUCENA AFH",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-16",
        "last_updated": "2014-10-16",
        "status": "A",
        "authorized_official_last_name": "AZUCENA",
        "authorized_official_first_name": "MAXIMO",
        "authorized_official_middle_name": "DIMAUNAHAN",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "425-322-5328"
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "WA",
            "license": "751038",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1115019",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• MBHC LLC

• Exclusive Provider Organization in Everett, WA
• Providers in Everett, WA by specialty
• Exclusive Provider Organization in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.