Provider Demographics
NPI:1649776170
Name:AL MANA, ABDULAZIZ FAHED (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDULAZIZ
Middle Name:FAHED
Last Name:AL MANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 NW 12TH AVE, ROOM 2044
Mailing Address - Street 2:PATHOLOGY RESIDENCY PROGRAM COORDINATOR, HOLTZ CENTER
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136
Mailing Address - Country:US
Mailing Address - Phone:305-585-8381
Mailing Address - Fax:305-585-2598
Practice Address - Street 1:1611 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136
Practice Address - Country:US
Practice Address - Phone:305-585-8381
Practice Address - Fax:305-585-2598
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2019-04-22
Deactivation Date:2018-11-16
Deactivation Code:
Reactivation Date:2019-04-22
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program