Provider Demographics
NPI:1073126041
Name:AZUL CLINIC CORP
Entity Type:Organization
Organization Name:AZUL CLINIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:DELICIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-587-9432
Mailing Address - Street 1:8245 NW 36TH ST STE 3
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6636
Mailing Address - Country:US
Mailing Address - Phone:786-587-9432
Mailing Address - Fax:
Practice Address - Street 1:8245 NW 36TH ST STE 3
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6636
Practice Address - Country:US
Practice Address - Phone:786-587-9432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management