Provider Demographics
NPI:1730629882
Name:AZUA, OSWALD (CRT)
Entity type:Individual
Prefix:
First Name:OSWALD
Middle Name:
Last Name:AZUA
Suffix:
Gender:M
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9965 NW 25TH TER
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-1346
Mailing Address - Country:US
Mailing Address - Phone:786-399-5423
Mailing Address - Fax:
Practice Address - Street 1:9965 NW 25TH TER
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-1346
Practice Address - Country:US
Practice Address - Phone:786-399-5423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTT15470227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified