Provider Demographics
NPI:1871127415
Name:DAZA SUNIAGA, MIGUEL AUGUSTO (SA-C)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:AUGUSTO
Last Name:DAZA SUNIAGA
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11551 LAKESIDE DR APT 7104
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-3020
Mailing Address - Country:US
Mailing Address - Phone:239-285-1798
Mailing Address - Fax:
Practice Address - Street 1:11551 LAKESIDE DR APT 7104
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-3020
Practice Address - Country:US
Practice Address - Phone:239-285-1798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-22
Last Update Date:2020-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19-252246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant