Provider Demographics
NPI:1699466136
Name:DAZA, DAVID M
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:DAZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10310 QUEENS BLVD APT 5F
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3190
Mailing Address - Country:US
Mailing Address - Phone:347-735-1063
Mailing Address - Fax:
Practice Address - Street 1:18709 LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-4025
Practice Address - Country:US
Practice Address - Phone:718-500-5549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health