Individual
DR. AZITA DJALILVAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
655 W 8TH ST, UFJP PATHOLOGY, JACKSONVILLE, FL 32209-6511
(904) 244-4218
(904) 244-4290
Mailing address
PO BOX 44008, UFJP PROVIDER ENROLLMENT, JACKSONVILLE, FL 32231-4008
(904) 244-3660
(904) 244-3425
Taxonomy
Speciality
Code
Description
License number
State
207ZP0007X
Molecular Genetic Pathology (Pathology) Physician
ME96075
FL
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
ME96075
FL
Other
Enumeration date
06/19/2006
Last updated
01/30/2008
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