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General NPI Number Information
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NPI Number | 1518438936
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Entity Type | Organization
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Legal Business Name | YAZJI PEDIATRIC CARE
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Dates
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Enumeration Date | 12/11/2018
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Last Update Date | 07/03/2019
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Provider Practice Location Address
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Address Line | 4125 RACE TRACK RD SUITE NUMBER 104
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City | SAINT JOHNS
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State | FL
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Zip | 32259
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Country | US
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Telephone | 904-338-1004
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Fax |
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Provider Business Mailing Address
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Address Line | 8669 MABEL DR
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City | JACKSONVILLE
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State | FL
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Zip | 32256-1948
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Country | US
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Telephone | 904-338-1004
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Fax |
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DR. ANAS AL YAZJI
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Credential | MD
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Telephone | 904-222-6364
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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