Healthcare Provider Details

I. General information

NPI: 1528009339
Provider Name (Legal Business Name): IA B ZAGVAZDINA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 12/15/2023
Certification Date: 12/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 S STATE ROAD 7
HOLLYWOOD FL
33023-6718
US

IV. Provider business mailing address

390 S STATE ROAD 7
HOLLYWOOD FL
33023-6718
US

V. Phone/Fax

Practice location:
  • Phone: 954-743-5522
  • Fax: 954-743-5632
Mailing address:
  • Phone: 954-743-5522
  • Fax: 954-743-5632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME82035
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: