Provider Demographics
NPI:1821086349
Name:AZAN, ALEX (PHD)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:AZAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 NE 125TH ST
Mailing Address - Street 2:SUITE 409
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5821
Mailing Address - Country:US
Mailing Address - Phone:888-852-6672
Mailing Address - Fax:305-891-4228
Practice Address - Street 1:11440 N KENDALL DR
Practice Address - Street 2:STE 208
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1024
Practice Address - Country:US
Practice Address - Phone:888-852-6672
Practice Address - Fax:305-891-4228
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4586103T00000X, 103TC0700X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL541072Medicare ID - Type Unspecified
FL54107ZMedicare PIN