Healthcare Provider Details

I. General information

NPI: 1659054245
Provider Name (Legal Business Name): ADAM AFZALI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2023
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10910 SW 165TH TER
MIAMI FL
33157-2823
US

IV. Provider business mailing address

10910 SW 165TH TER
MIAMI FL
33157-2823
US

V. Phone/Fax

Practice location:
  • Phone: 305-910-5978
  • Fax:
Mailing address:
  • Phone: 305-910-5978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: