Provider Demographics
NPI:1639128333
Name:AZZINARO, GUY WILLIAM (ARDMS)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:WILLIAM
Last Name:AZZINARO
Suffix:
Gender:M
Credentials:ARDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 BEL AIR AVE
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-7672
Mailing Address - Country:US
Mailing Address - Phone:954-473-1363
Mailing Address - Fax:954-382-2136
Practice Address - Street 1:1821 BEL AIR AVE
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-7672
Practice Address - Country:US
Practice Address - Phone:954-473-1363
Practice Address - Fax:954-382-2136
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL182142471S1302X, 2471V0105X, 2471V0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
No2471V0106XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular-Interventional Technology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU1403Medicare PIN