Provider Demographics
NPI:1679325708
Name:BLAIR, ZIZAH-WOSSENI JAHMILA
Entity Type:Individual
Prefix:
First Name:ZIZAH-WOSSENI
Middle Name:JAHMILA
Last Name:BLAIR
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 1:1520 SW 97TH TER
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3693
Mailing Address - Country:US
Mailing Address - Phone:954-249-3093
Mailing Address - Fax:
Practice Address - Street 1:1520 SW 97TH TER
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-3693
Practice Address - Country:US
Practice Address - Phone:954-249-3093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program