Healthcare Provider Details

I. General information

NPI: 1427341296
Provider Name (Legal Business Name): MARIANA KHAWAND-AZOULAI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 03/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NW 12TH AVE FL 11
MIAMI FL
33136-1003
US

IV. Provider business mailing address

1400 NW 12TH AVE FL 11
MIAMI FL
33136-1003
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-6668
  • Fax:
Mailing address:
  • Phone: 305-243-6668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberME121146
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: