Healthcare Provider Details

I. General information

NPI: 1346336674
Provider Name (Legal Business Name): MARJAN MIRZABEIGI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S ANDREWS AVE
FT LAUDERDALE FL
33316-2510
US

IV. Provider business mailing address

3141 W MCNAB RD
POMPANO BEACH FL
33069-4806
US

V. Phone/Fax

Practice location:
  • Phone: 954-355-5569
  • Fax: 954-355-5568
Mailing address:
  • Phone: 954-977-6977
  • Fax: 954-977-6922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberME91584
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: