Healthcare Provider Details

I. General information

NPI: 1649776170
Provider Name (Legal Business Name): ABDULAZIZ FAHED AL MANA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date: 11/16/2018
Reactivation Date: 04/22/2019

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136
US

IV. Provider business mailing address

1611 NW 12TH AVE, ROOM 2044 PATHOLOGY RESIDENCY PROGRAM COORDINATOR, HOLTZ CENTER
MIAMI FL
33136
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-8381
  • Fax: 305-585-2598
Mailing address:
  • Phone: 305-585-8381
  • Fax: 305-585-2598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License NumberME155744
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME155744
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: