Provider Information for 1538832308
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ROBERT GLENN AZZARITO
Sex: Male
NPI: 1538832308
Last Updated: 2024-07-17
Certification Date: 2024-07-17
Certification Date: 2024-07-17
Details
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NPI | 1538832308 | ||||||||||||
Enumeration Date | 2021-07-28 | ||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||
Sole Proprietor | YES | ||||||||||||
Status | Active | ||||||||||||
Mailing Address | 5550 RYAN LN CARMICHAEL, CA 95608-3037 United States Phone: 540-207-1037 | Fax: | ||||||||||||
Primary Practice Address | 5550 RYAN LN CARMICHAEL, CA 95608-3037 United States Phone: 540-207-1037 | Fax: | ||||||||||||
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