Healthcare Provider Details

I. General information

NPI: 1194838904
Provider Name (Legal Business Name): YANIRA RAZA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4125 S TAMIAMI TRL STE 2
VENICE FL
34293-5121
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 200
MIAMI FL
33126-3168
US

V. Phone/Fax

Practice location:
  • Phone: 941-584-9201
  • Fax:
Mailing address:
  • Phone: 305-709-2877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number210466
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: