MEDICARE: FARAHNAZ REBECCA HADJIMIRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA9112433	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952961427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FARAHNAZ REBECCA HADJIMIRY

Provider Business Mailing Address
First Line	:	2923 S FEDERAL HWY STE 100
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-7745
Country	:	US
Telephone Number	:	561-752-0100
Fax Number	:	561-740-3001

Provider Business Practice Location Address
First Line	:	2923 S FEDERAL HWY STE 100
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-7745
Country	:	US
Telephone Number	:	561-752-0100
Fax Number	:	561-740-3001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2019
Last Update Date	:	08/18/2021

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