Provider Demographics
NPI:1437344926
Name:ABDELAZIZ, RANDA YAZMIN (LMT)
Entity Type:Individual
Prefix:MS
First Name:RANDA
Middle Name:YAZMIN
Last Name:ABDELAZIZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4699 N STATE ROAD 7
Mailing Address - Street 2:SUITE B2
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33319-5879
Mailing Address - Country:US
Mailing Address - Phone:954-486-1925
Mailing Address - Fax:954-486-1983
Practice Address - Street 1:4699 N STATE ROAD 7
Practice Address - Street 2:SUITE B2
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-5879
Practice Address - Country:US
Practice Address - Phone:954-486-1925
Practice Address - Fax:954-486-1983
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-08
Last Update Date:2007-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA48550171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA48550OtherLICENSE