Healthcare Provider Details

I. General information

NPI: 1437344926
Provider Name (Legal Business Name): RANDA YAZMIN ABDELAZIZ LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2007
Last Update Date: 09/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4699 N STATE ROAD 7 SUITE B2
LAUDERDALE LAKES FL
33319-5879
US

IV. Provider business mailing address

4699 N STATE ROAD 7 SUITE B2
LAUDERDALE LAKES FL
33319-5879
US

V. Phone/Fax

Practice location:
  • Phone: 954-486-1925
  • Fax: 954-486-1983
Mailing address:
  • Phone: 954-486-1925
  • Fax: 954-486-1983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberMA48550
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: