Healthcare Provider Details

I. General information

NPI: 1639128333
Provider Name (Legal Business Name): GUY WILLIAM AZZINARO ARDMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 11/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 BEL AIR AVE
POMPANO BEACH FL
33062-7672
US

IV. Provider business mailing address

1821 BEL AIR AVE
POMPANO BEACH FL
33062-7672
US

V. Phone/Fax

Practice location:
  • Phone: 954-473-1363
  • Fax: 954-382-2136
Mailing address:
  • Phone: 954-473-1363
  • Fax: 954-382-2136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number18214
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number18214
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: