Provider Demographics
NPI:1295980431
Name:TAGHAVY, AZITA (MD)
Entity type:Individual
Prefix:
First Name:AZITA
Middle Name:
Last Name:TAGHAVY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 BON AIR RD
Mailing Address - Street 2:
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1702
Mailing Address - Country:US
Mailing Address - Phone:510-230-3320
Mailing Address - Fax:
Practice Address - Street 1:250 BON AIR RD,
Practice Address - Street 2:MARIN GENERAL HOSPITAL
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2000
Practice Address - Country:US
Practice Address - Phone:510-230-3320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA114414174400000X
CA282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care HospitalGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty