Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | DC26068 | CA |
NPI | 1720383151 |
---|---|
Provider Name | Dr. Channing Azzolino |
First Address | Danville, CA 94526-4414 |
Second Address | Danville, CA 94526-4414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2011 |
Last Update Date | 15/01/2011 |