Healthcare Provider Details

I. General information

NPI: 1063972719
Provider Name (Legal Business Name): MINA DAOUD AZIZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3411 WAYNE AVE
BRONX NY
10467-2509
US

IV. Provider business mailing address

3411 WAYNE AVE
BRONX NY
10467-2509
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-2680
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number322910-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: