Provider Demographics
NPI:1710748199
Name:AZULLA COMMUNITY HEALTH CENTER, INC
Entity Type:Organization
Organization Name:AZULLA COMMUNITY HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VENTRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS-VICTOR
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-C
Authorized Official - Phone:561-401-8018
Mailing Address - Street 1:2677 FOREST HILL BLVD STE 125
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33406-5941
Mailing Address - Country:US
Mailing Address - Phone:561-725-4971
Mailing Address - Fax:
Practice Address - Street 1:8304 W OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-7308
Practice Address - Country:US
Practice Address - Phone:561-725-4971
Practice Address - Fax:561-855-8872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care