1164693537 NPI number — MAAZALI LLC

Table of content: (NPI 1164693537)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164693537 NPI number — MAAZALI LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAAZALI LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164693537
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11451 CORTEZ BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKSVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34613-7367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-797-9677
Provider Business Mailing Address Fax Number:
352-600-8913

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14540 CORTEZ BLVD
Provider Second Line Business Practice Location Address:
SUITE # 116
Provider Business Practice Location Address City Name:
BROOKSVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34613-6056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-797-9677
Provider Business Practice Location Address Fax Number:
352-797-9857
Provider Enumeration Date:
03/13/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ALI
Authorized Official First Name:
SYED
Authorized Official Middle Name:
WAJAHAT
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
352-797-9677

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  ME83482 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 264459200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com