Provider Demographics
NPI:1497387211
Name:AZIZ, NIDA
Entity Type:Individual
Prefix:
First Name:NIDA
Middle Name:
Last Name:AZIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15911 SW 56TH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHWEST RANCHES
Mailing Address - State:FL
Mailing Address - Zip Code:33331-2876
Mailing Address - Country:US
Mailing Address - Phone:954-410-8277
Mailing Address - Fax:
Practice Address - Street 1:15911 SW 56TH ST
Practice Address - Street 2:
Practice Address - City:SOUTHWEST RANCHES
Practice Address - State:FL
Practice Address - Zip Code:33331-2876
Practice Address - Country:US
Practice Address - Phone:954-410-8277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17304103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling