Healthcare Provider Details

I. General information

NPI: 1164176822
Provider Name (Legal Business Name): PROMAZ TRADING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2022
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 KENNEWICK CT
WESLEY CHAPEL FL
33543-7673
US

IV. Provider business mailing address

1211 KENNEWICK CT
WESLEY CHAPEL FL
33543-7673
US

V. Phone/Fax

Practice location:
  • Phone: 813-388-9333
  • Fax:
Mailing address:
  • Phone: 813-388-9333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARBEL JOSEPH MAZRAANI
Title or Position: MANAGER
Credential: MBA
Phone: 813-388-9333