Provider Demographics
NPI:1821892167
Name:DAZZA, KARINNA VANESSA
Entity type:Individual
Prefix:
First Name:KARINNA
Middle Name:VANESSA
Last Name:DAZZA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4950 WASHINGTON ST APT 126
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-7681
Mailing Address - Country:US
Mailing Address - Phone:754-366-3739
Mailing Address - Fax:
Practice Address - Street 1:4950 WASHINGTON ST APT 126
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-7681
Practice Address - Country:US
Practice Address - Phone:754-366-3739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-03
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician