MEDICARE: JENNIFER DAZA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor		FL

General Provider Information

NPI Number	:	1851808679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER DAZA

Provider Business Mailing Address
First Line	:	15613 SW 39TH ST
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33027-4801
Country	:	US
Telephone Number	:	954-376-9607
Fax Number	:

Provider Business Practice Location Address
First Line	:	15613 SW 39TH ST
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33027-4801
Country	:	US
Telephone Number	:	954-376-9607
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2018
Last Update Date	:	01/26/2025

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