Provider Demographics
NPI:1730631318
Name:SANOUFA, MAZEN (MD)
Entity type:Individual
Prefix:
First Name:MAZEN
Middle Name:
Last Name:SANOUFA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 W 49TH PL
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3113
Mailing Address - Country:US
Mailing Address - Phone:305-615-7334
Mailing Address - Fax:
Practice Address - Street 1:1475 W 49TH PL
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3113
Practice Address - Country:US
Practice Address - Phone:305-558-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-28
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN36314207RN0300X, 207RN0300X
261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health