Healthcare Provider Details

I. General information

NPI: 1730629882
Provider Name (Legal Business Name): OSWALD AZUA CRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2017
Last Update Date: 03/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9965 NW 25TH TER
DORAL FL
33172-1346
US

IV. Provider business mailing address

9965 NW 25TH TER
DORAL FL
33172-1346
US

V. Phone/Fax

Practice location:
  • Phone: 786-399-5423
  • Fax:
Mailing address:
  • Phone: 786-399-5423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberTT15470
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: