Active NPI
Michelle Mae Azurin
- Medical Physician Assistant
- South Gate, CA
National Provider Identifier
1457660391
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 52600
- Practice address
- 4075 Tweedy Blvd
South Gate, CA 90280-6146 - Phone
- (323) 566-4111
- NPI assigned
- Sep 27, 2010
- Last updated
- Oct 18, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 52600 | CA | Primary |
Addresses
Primary practice location
4075 Tweedy Blvd
South Gate, CA 90280-6146
Mailing address
4075 Tweedy Blvd
South Gate, CA 90280-6185
Phone (323) 566-4111
Other names 1
- Michelle Mae Domingo
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151001002076 | CA | Practitioner - Physician Assistant | 0446568984 |
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- University of Southern California Keck School of Medicine, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Narciso M Azurin M D Inc
Practice addresses (Care Compare)
4075 Tweedy Blvd
South Gate, CA 90280-6146
Phone (323) 566-4111
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 52600 | CA | MD | Specialist |
Interoperability endpoints
- michelle.domingo@tmg-ca.direct.office.nextgen.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1285545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1792281600000",
"number": "1457660391",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4075 TWEEDY BLVD",
"city": "SOUTH GATE",
"state": "CA",
"postal_code": "902806185",
"telephone_number": "323-566-4111",
"fax_number": "323-563-0439"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4075 TWEEDY BLVD",
"city": "SOUTH GATE",
"state": "CA",
"postal_code": "902806146",
"telephone_number": "323-566-4111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AZURIN",
"first_name": "MICHELLE",
"middle_name": "MAE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-09-27",
"last_updated": "2026-10-18",
"certification_date": "2026-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "CA",
"license": "52600",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MICHELLE",
"last_name": "DOMINGO",
"middle_name": "MAE",
"credential": "PA-C",
"code": "1",
"type": "Former Name"
}
]
}Other providers in South Gate, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.