Healthcare Provider Details

I. General information

NPI: 1568491009
Provider Name (Legal Business Name): NEDA RIAHI VANDEN BOSCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 05/15/2021
Certification Date: 05/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3618 LANTANA RD STE 101
LAKE WORTH FL
33462-2247
US

IV. Provider business mailing address

3618 LANTANA RD STE 101
LAKE WORTH FL
33462-2247
US

V. Phone/Fax

Practice location:
  • Phone: 561-357-2020
  • Fax: 561-357-2022
Mailing address:
  • Phone: 561-357-2020
  • Fax: 561-357-2022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME85257
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: