Healthcare Provider Details

I. General information

NPI: 1285932095
Provider Name (Legal Business Name): MZ PROFESSIONAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2011
Last Update Date: 11/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7481 W. OAKLAND PARK BLVD. STE 100
LAUDERHILL FL
33319-4985
US

IV. Provider business mailing address

1065 NE 125TH ST STE 409
NORTH MIAMI FL
33161-5821
US

V. Phone/Fax

Practice location:
  • Phone: 888-852-6672
  • Fax: 305-891-4228
Mailing address:
  • Phone: 888-852-6672
  • Fax: 305-891-4228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME54504
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME54504
License Number StateFL

VIII. Authorized Official

Name: SOHAIL PUNJWANI
Title or Position: CEO/PRESIDENT
Credential: M.D.
Phone: 719-285-5121