| Organization Name: | ABDUL KHALIL WALLIZADA,MD |
| NPI Number: | 1053360669 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ABDUL KHALIL WALLIZADA (OWNER) |
| Mailing Address: | 2140 Kingsley Ave Ste.#10 Orange Park |
| State: | FL US |
| Postal Code: | 320735180 |
| Phone Number: | 9042760005 |
| Fax Number: | 9042769202 |
| NPI Enumeration Date: | 05/09/2006 |
| NPI Last Update Date: | 07/07/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2080A0000X |
| License Number: | ME0067026 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Pediatrics |
| Taxonomy Specialization: | Adolescent Medicine |
| Taxonomy Definition: | A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. |