Provider Demographics
NPI:1376624957
Name:FAZAL, DYLIA E
Entity Type:Individual
Prefix:DR
First Name:DYLIA
Middle Name:E
Last Name:FAZAL
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:DYLIA
Other - Middle Name:E
Other - Last Name:DONATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:230 LONGVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:44452-9552
Mailing Address - Country:US
Mailing Address - Phone:330-549-0992
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 981 ,SECTOR SABANA
Practice Address - Street 2:HOUSE NUMBER 3
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771-0449
Practice Address - Country:US
Practice Address - Phone:787-733-2438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9993208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics