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General NPI Number Information
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NPI Number | 1114724465
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Entity Type | Organization
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Legal Business Name | AZURE AESTHETICS AND OCULOFACIAL PLASTIC SURGERY PC
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Dates
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Enumeration Date | 02/25/2025
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 4590 MAIN ST
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City | SNYDER
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State | NY
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Zip | 14226-4548
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Country | US
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Telephone | 585-319-2284
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Fax |
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Provider Business Mailing Address
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Address Line | 4590 MAIN ST
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City | SNYDER
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State | NY
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Zip | 14226-4548
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Country | US
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Telephone | 585-319-2284
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Fax |
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Authorized Official
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Title or Position | MD/OWNER
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Name | DR. MITHRA GONZALEZ
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Credential | MD
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Telephone | 585-319-2284
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207WX0200X
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Taxonomy Name | Ophthalmic Plastic and Reconstructive Surgery Physician
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License Number |
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License Number State |
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