Healthcare Provider Details

I. General information

NPI: 1417159682
Provider Name (Legal Business Name): FATEMEH RHANA MOUSAVI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5361 NW 33RD AVE
FT LAUDERDALE FL
33309-6313
US

IV. Provider business mailing address

10425 AVENIDA DEL RIO
DELRAY BEACH FL
33446-2417
US

V. Phone/Fax

Practice location:
  • Phone: 954-717-0300
  • Fax: 561-270-0391
Mailing address:
  • Phone: 561-306-4906
  • Fax: 561-270-0391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberME94764
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME94764
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberME94764
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: