Provider Demographics
NPI:1750847240
Name:AZIZA, VINCENT
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:
Last Name:AZIZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4614 COBBLE GROVE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-2261
Mailing Address - Country:US
Mailing Address - Phone:832-372-2086
Mailing Address - Fax:
Practice Address - Street 1:9207 COUNTRY CREEK DR STE 202
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-7711
Practice Address - Country:US
Practice Address - Phone:713-778-0463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63949183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX63949OtherLIC NUMBER