Provider Demographics
NPI:1205139276
Name:DAZA, PAOLA VERONICA (MD)
Entity type:Individual
Prefix:DR
First Name:PAOLA
Middle Name:VERONICA
Last Name:DAZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PAOLA
Other - Middle Name:VERONICA
Other - Last Name:PADERES TORRICO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1395 NW 167TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5710
Mailing Address - Country:US
Mailing Address - Phone:305-827-2977
Mailing Address - Fax:
Practice Address - Street 1:410 E HALLANDALE BEACH BLVD
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-5529
Practice Address - Country:US
Practice Address - Phone:305-827-2977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME151867207Q00000X
VA0101257474208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine