Provider Demographics
NPI:1023451366
Name:EL-AYAZRA, EMIL
Entity type:Individual
Prefix:
First Name:EMIL
Middle Name:
Last Name:EL-AYAZRA
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 1:7350 WICHITA CT
Mailing Address - Street 2:APT. 23
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-6462
Mailing Address - Country:US
Mailing Address - Phone:229-356-8685
Mailing Address - Fax:
Practice Address - Street 1:7350 WICHITA CT
Practice Address - Street 2:APT. 23
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-6462
Practice Address - Country:US
Practice Address - Phone:229-356-8685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131001128224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant