Individual provider Active NPI

Azadeh Rose Fayazi, MD

  • Pediatric Critical Care Medicine Physician
  • Palo Alto, CA
National Provider Identifier
1639388994
Registry record updated Apr 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X
License
A115936 Issued in CA
Practice address
725 Welch Rd
Palo Alto, CA 94304-1601
Phone
(650) 497-8000
NPI assigned
May 22, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Critical Care Medicine Physician 2080P0203X A115936 CA Primary
Pediatrics Physician 208000000X A115936 CA

Addresses

Primary practice location

725 Welch Rd
Palo Alto, CA 94304-1601

Mailing address

725 Welch Rd
Palo Alto, CA 94304-1601
Phone (650) 497-8000

Other practice location 1

630 Park View Dr Apt 212
Santa Clara, CA 95054-3580
Phone (614) 286-5096

Other practice location 2

630 Park View Dr Apt 212
Santa Clara, CA 95054-3580
Phone (614) 286-5096

Other practice location 3

770 Welch Rd
Palo Alto, CA 94304
Phone (650) 736-9828

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121012000722 CA Practitioner - Pediatric Medicine 2769631431 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A115936CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
LPCH Medical Group Div of Lucile Pediatrics CurrentSince Nov 11, 2016 Accepting new patients

Locations

9300 Valley Childrens Pl
Madera, CA 93636
Phone (559) 353-5700

770 Welch Rd
Palo Alto, CA 94304
Phone (650) 498-4069

725 Welch Rd
Palo Alto, CA 94304
Phone (650) 497-8979

1150 Veterans Blvd
Redwood City, CA 94063
Phone (650) 299-2015

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712793600000",
    "number": "1639388994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 WELCH RD",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943041601",
            "telephone_number": "650-497-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 WELCH RD",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943041601",
            "telephone_number": "650-497-8000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "630 Park View Dr Apt 212",
            "address_purpose": "LOCATION",
            "city": "Santa Clara",
            "state": "CA",
            "postal_code": "950543580",
            "country_code": "US",
            "telephone_number": "614-286-5096",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "630 Park View Dr Apt 212",
            "address_purpose": "LOCATION",
            "city": "Santa Clara",
            "state": "CA",
            "postal_code": "950543580",
            "country_code": "US",
            "telephone_number": "614-286-5096",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "770 Welch Rd",
            "address_purpose": "LOCATION",
            "city": "Palo Alto",
            "state": "CA",
            "postal_code": "94304",
            "country_code": "US",
            "telephone_number": "650-736-9828",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAYAZI",
        "first_name": "AZADEH",
        "middle_name": "ROSE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-22",
        "last_updated": "2024-04-11",
        "certification_date": "2024-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "CA",
            "license": "A115936",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A115936",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palo Alto, CA

Sources for this page

Verify at the official NPI Registry.