Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | PENDING | FL |
NPI | 1003427675 |
---|---|
Provider Name | Matthew Aziz Faheim Hanna |
First Address | South Miami, FL 33143-4701 |
Second Address | South Miami, FL 33143-4701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2020 |
Last Update Date | 16/08/2020 |