Healthcare Provider Details

I. General information

NPI: 1447591508
Provider Name (Legal Business Name): RAUL BLANCO AZCUY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2013
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6517 TAFT ST
HOLLYWOOD FL
33024-4062
US

IV. Provider business mailing address

8333 NW 53RD ST FL 6
DORAL FL
33166-4783
US

V. Phone/Fax

Practice location:
  • Phone: 954-218-5751
  • Fax: 954-708-1391
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1354
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number15224-I
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: