Provider Demographics
NPI:1164432050
Name:DAZA, RAUL E (MD)
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:E
Last Name:DAZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 NW 33RD ST
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1937
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18610 NW 87TH AVE
Practice Address - Street 2:SUITE 101 AND 201
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-3518
Practice Address - Country:US
Practice Address - Phone:844-665-4827
Practice Address - Fax:305-829-5033
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96199207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276387700Medicaid
FLME96199OtherMEDICAL LICENSE