Provider Demographics
NPI:1013772854
Name:BAAZAOUI, MONCEF
Entity Type:Individual
Prefix:
First Name:MONCEF
Middle Name:
Last Name:BAAZAOUI
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 1:36512 GARDEN WALL WAY
Mailing Address - Street 2:ZEPHYRHILLS, FL 33541
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33541
Mailing Address - Country:US
Mailing Address - Phone:813-357-4489
Mailing Address - Fax:813-797-9201
Practice Address - Street 1:36512 GARDEN WALL WAY
Practice Address - Street 2:ZEPHYRHILLS, FL 33541
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33541
Practice Address - Country:US
Practice Address - Phone:813-357-4489
Practice Address - Fax:813-797-9201
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLB200541684090172A00000X
FLH250259773630172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver