Healthcare Provider Details

I. General information

NPI: 1477138410
Provider Name (Legal Business Name): DAVID MIZRAHI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2021
Last Update Date: 03/11/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3405 NW 36TH STREET SUITE 112
VIRGINIA GARDENS FL
33166
US

IV. Provider business mailing address

4050 NW 42ND AVE APT 215
LAUDERDALE LAKES FL
33319-4847
US

V. Phone/Fax

Practice location:
  • Phone: 305-871-3131
  • Fax:
Mailing address:
  • Phone: 786-237-1141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberIMH19941
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: