Individual provider Active NPI

Mandana Azar, M.D.

  • Internal Medicine Physician
  • Thousand Oaks, CA
National Provider Identifier
1851612402
Registry record updated Apr 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A73701 Issued in CA
Practice address
425 Haaland Dr Ste 200
Thousand Oaks, CA 91361-5231
Phone
(805) 373-7073
NPI assigned
Jun 17, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 11, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A73701 CA Primary

Addresses

Primary practice location

425 Haaland Dr Ste 200
Thousand Oaks, CA 91361-5231

Mailing address

PO Box 1027
Thousand Oaks, CA 91358-0027

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A73701CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rolling Oaks Surgery Center LLC Past Accepting new patients
Kouros Azar, MD a Professional Corporation PastSince May 13, 2010 Accepting new patients

Organizations & group practices 2

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": "1276732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365638400000",
    "number": "1851612402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1027",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913580027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 HAALAND DR STE 200",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913615231",
            "telephone_number": "805-373-7073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AZAR",
        "first_name": "MANDANA",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-06-17",
        "last_updated": "2013-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A73701",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Thousand Oaks, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2013; 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.