Provider Demographics
NPI:1568530673
Name:DAJUD-AZUERO, MARIA-VICTORIA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA-VICTORIA
Middle Name:
Last Name:DAJUD-AZUERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA-VICTORIA
Other - Middle Name:
Other - Last Name:DAJUD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1300 SAWGRASS CORPORATE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2823
Mailing Address - Country:US
Mailing Address - Phone:800-243-3839
Mailing Address - Fax:855-527-5510
Practice Address - Street 1:3030 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6308
Practice Address - Country:US
Practice Address - Phone:813-879-4730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA36669208000000X
FLME133046208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1568530673Medicaid
GA003108798AMedicaid