1932420544 NPI number — MRS. MANDANA ALBORZFARD DIXON ARNP

Table of content: MRS. MANDANA ALBORZFARD DIXON ARNP (NPI 1932420544)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932420544 NPI number — MRS. MANDANA ALBORZFARD DIXON ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIXON
Provider First Name:
MANDANA
Provider Middle Name:
ALBORZFARD
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

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:
1932420544
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
555 W STATE ROAD 434
Provider Second Line Business Mailing Address:
MP SS ADMIN
Provider Business Mailing Address City Name:
LONGWOOD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32750-5119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-842-2994
Provider Business Mailing Address Fax Number:
407-767-5801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 W STATE ROAD 434
Provider Second Line Business Practice Location Address:
MP SS ADMIN
Provider Business Practice Location Address City Name:
LONGWOOD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32750-5119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-842-2994
Provider Business Practice Location Address Fax Number:
407-767-5801
Provider Enumeration Date:
06/17/2010

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: 363L00000X , with the licence number:  ARNP9238785 , 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: ARNP9238785 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 002556100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".