Healthcare Provider Details

I. General information

NPI: 1104121870
Provider Name (Legal Business Name): NOOSHIN ZOLFAGHARI DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2011
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2699 STIRLING RD SUITE A301
FORT LAUDERDALE FL
33312-6517
US

IV. Provider business mailing address

14730 SW 4TH ST
PEMBROKE PINES FL
33027-6107
US

V. Phone/Fax

Practice location:
  • Phone: 954-278-3890
  • Fax: 954-251-1470
Mailing address:
  • Phone: 954-899-0520
  • Fax: 954-437-3468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number3442
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: