MEDICARE: DR. MIGUEL ANTONIO DE AZA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	146D00000X	Personal Emergency Response Attendant	15822	PR
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1336103019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIGUEL ANTONIO DE AZA MD

Provider Business Mailing Address
First Line	:	2030 TILGHMAN ST
Second Line	:	LVCMHC INC
City	:	ALLENTOWN
State	:	PA
Zip	:	18104-4354
Country	:	US
Telephone Number	:	484-221-9135
Fax Number	:	484-221-9130

Provider Business Practice Location Address
First Line	:	2957 NORTH 5TH ST
Second Line	:	2ND FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19133-2800
Country	:	US
Telephone Number	:	484-221-9135
Fax Number	:	484-221-9130

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	03/18/2008

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