MEDICARE: IZMIR ERAZO

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CAC2787A	FL

General Provider Information

NPI Number	:	1831382910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IZMIR ERAZO

Provider Business Mailing Address
First Line	:	2175 N UNIVERSITY DR
Second Line	:
City	:	SUNRISE
State	:	FL
Zip	:	33322-3938
Country	:	US
Telephone Number	:	954-578-7684
Fax Number	:	954-578-7689

Provider Business Practice Location Address
First Line	:	2175 N UNIVERSITY DR
Second Line	:
City	:	SUNRISE
State	:	FL
Zip	:	33322-3938
Country	:	US
Telephone Number	:	954-578-7684
Fax Number	:	954-578-7689

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

Provider Enumeration Date	:	08/22/2007
Last Update Date	:	08/22/2007

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Directions to “ IZMIR ERAZO ” Practice Location

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