1376732453 NPI number — FIRAZ R HOSEIN DO PA

Table of content: (NPI 1376732453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376732453 NPI number — FIRAZ R HOSEIN DO PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRAZ R HOSEIN DO PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376732453
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P. O. BOX 970465
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COCONUT CREEK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33097-0465
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-782-3170
Provider Business Mailing Address Fax Number:
954-782-3171

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 W SAMPLE RD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
POMPANO BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-782-3170
Provider Business Practice Location Address Fax Number:
954-782-3171
Provider Enumeration Date:
10/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HOSEIN
Authorized Official First Name:
FIRAZ
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
954-782-3170

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  OS8550 , 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: 268249400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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