Provider Demographics
NPI:1033588603
Name:DAZA, MONICA (SA-C)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:DAZA
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12025 W GREENWAY DR
Mailing Address - Street 2:APT #104
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-2849
Mailing Address - Country:US
Mailing Address - Phone:561-503-9408
Mailing Address - Fax:
Practice Address - Street 1:12025 W GREENWAY DR
Practice Address - Street 2:APT #104
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-2849
Practice Address - Country:US
Practice Address - Phone:561-503-9408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant