Provider Demographics
NPI:1518438936
Name:YAZJI PEDIATRIC CARE
Entity Type:Organization
Organization Name:YAZJI PEDIATRIC CARE
Other - Org Name:TUKA PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANAS
Authorized Official - Middle Name:
Authorized Official - Last Name:AL YAZJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-222-6364
Mailing Address - Street 1:8669 MABEL DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-1948
Mailing Address - Country:US
Mailing Address - Phone:904-338-1004
Mailing Address - Fax:
Practice Address - Street 1:4125 RACE TRACK RD
Practice Address - Street 2:SUITE NUMBER 104
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259
Practice Address - Country:US
Practice Address - Phone:904-338-1004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-11
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty