Healthcare Provider Details

I. General information

NPI: 1629711171
Provider Name (Legal Business Name): DAVID AZOR FERNANDEZ-HAZOURY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST
TORRANCE CA
90502-2059
US

IV. Provider business mailing address

801 N VENETIAN DR APT 505
MIAMI BEACH FL
33139-1006
US

V. Phone/Fax

Practice location:
  • Phone: 424-306-6219
  • Fax:
Mailing address:
  • Phone: 352-406-9444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: