Provider Demographics
NPI:1235979840
Name:AZZAM, DOLLEN
Entity type:Individual
Prefix:
First Name:DOLLEN
Middle Name:
Last Name:AZZAM
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 1:501 N CRESCENT WAY
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-5401
Mailing Address - Country:US
Mailing Address - Phone:714-999-3511
Mailing Address - Fax:
Practice Address - Street 1:8281 WALKER ST
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-2196
Practice Address - Country:US
Practice Address - Phone:714-231-6012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool