Provider Demographics
NPI:1174875777
Name:OIEN, AZADEH NICOLE (DPT)
Entity type:Individual
Prefix:MS
First Name:AZADEH
Middle Name:NICOLE
Last Name:OIEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:25 FLAGSTONE CT
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:CA
Mailing Address - Zip Code:94507-1767
Mailing Address - Country:US
Mailing Address - Phone:310-547-7125
Mailing Address - Fax:
Practice Address - Street 1:5201 NORRIS CANYON RD STE 200
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-5405
Practice Address - Country:US
Practice Address - Phone:925-939-8585
Practice Address - Fax:925-933-2709
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-05
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA33866225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist