Provider Demographics
NPI:1063782886
Name:THOMAS-ALAZIZ, DYNA
Entity type:Individual
Prefix:
First Name:DYNA
Middle Name:
Last Name:THOMAS-ALAZIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5633 LAKE MURRAY BLVD UNIT C
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-1964
Mailing Address - Country:US
Mailing Address - Phone:619-550-8243
Mailing Address - Fax:
Practice Address - Street 1:1288 CAMINO DEL RIO N
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1511
Practice Address - Country:US
Practice Address - Phone:619-542-0292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66759183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist