Healthcare Provider Details

I. General information

NPI: 1609067131
Provider Name (Legal Business Name): ROSTISLAV IGNATOV, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 08/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 S FEDERAL HWY STE. 102
BOYNTON BEACH FL
33435-6000
US

IV. Provider business mailing address

PO BOX 547265
SURFSIDE FL
33154-7265
US

V. Phone/Fax

Practice location:
  • Phone: 305-924-6593
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME 93056
License Number StateFL

VIII. Authorized Official

Name: ROSTISLAV IGNATOV
Title or Position: PRESIDENT
Credential: M.D.
Phone: 305-924-6593