1013151141 NPI number — MRS. MUSHFEKA MOIZ GOLAWALA M.D

Table of content: MRS. MUSHFEKA MOIZ GOLAWALA M.D (NPI 1013151141)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013151141 NPI number — MRS. MUSHFEKA MOIZ GOLAWALA M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOLAWALA
Provider First Name:
MUSHFEKA
Provider Middle Name:
MOIZ
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAKER
Provider Other First Name:
MUSHFEKA
Provider Other Middle Name:
ZAKIUDDIN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1013151141
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20384 HACIENDA CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOCA RATON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33498-6603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-703-1383
Provider Business Mailing Address Fax Number:
561-423-8372

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20384 HACIENDA CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOCA RATON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33498-6603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-703-1383
Provider Business Practice Location Address Fax Number:
561-423-8372
Provider Enumeration Date:
04/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  ME 103852 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001133500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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