Provider Demographics
NPI:1760127534
Name:DE AZA, IRIDANIA (MS ED)
Entity Type:Individual
Prefix:
First Name:IRIDANIA
Middle Name:
Last Name:DE AZA
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 FIELDSTON TER APT 6C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-3035
Mailing Address - Country:US
Mailing Address - Phone:646-821-5164
Mailing Address - Fax:
Practice Address - Street 1:6214 RIVERDALE AVE # 1A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-1032
Practice Address - Country:US
Practice Address - Phone:718-701-4807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst