Healthcare Provider Details

I. General information

NPI: 1952540031
Provider Name (Legal Business Name): MAZALEZ COMPLETE WORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2009
Last Update Date: 02/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8004 NW 154TH ST SUITE 371
MIAMI LAKES FL
33016-5814
US

IV. Provider business mailing address

8004 NW 154TH ST SUITE 371
MIAMI LAKES FL
33016-5814
US

V. Phone/Fax

Practice location:
  • Phone: 305-529-4962
  • Fax: 305-675-6154
Mailing address:
  • Phone: 305-529-4962
  • Fax: 305-675-6154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0001X
TaxonomyClinical & Laboratory Immunology (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. ELMA GONZALEZ
Title or Position: PRESIDENT
Credential:
Phone: 786-234-0509