Healthcare Provider Details

I. General information

NPI: 1366889727
Provider Name (Legal Business Name): SAFIA ILYAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2013
Last Update Date: 05/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4413 WOODFIELD BLVD
BOCA RATON FL
33434-5303
US

IV. Provider business mailing address

4413 WOODFIELD BLVD
BOCA RATON FL
33434-5303
US

V. Phone/Fax

Practice location:
  • Phone: 561-789-9305
  • Fax:
Mailing address:
  • Phone: 561-789-9305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberTRN18840
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: