Provider Demographics
NPI:1942813498
Name:ALI, AZAR
Entity type:Individual
Prefix:
First Name:AZAR
Middle Name:
Last Name:ALI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2437 GREENDALE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-3927
Mailing Address - Country:US
Mailing Address - Phone:650-784-1186
Mailing Address - Fax:
Practice Address - Street 1:1420 WILLOW PASS RD # 200
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5823
Practice Address - Country:US
Practice Address - Phone:650-784-1186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2025-03-10
Deactivation Date:2022-11-08
Deactivation Code:
Reactivation Date:2022-11-16
Provider Licenses
StateLicense IDTaxonomies
WASC616048921041C0700X
CA112623104100000X, 101Y00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor