Healthcare Provider Details

I. General information

NPI: 1184651648
Provider Name (Legal Business Name): PARANDEH AMINI ALASHTI P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 ALTON RD #2070
MIAMI BEACH FL
33140-2800
US

IV. Provider business mailing address

PO BOX 402808
MIAMI BEACH FL
33140-0808
US

V. Phone/Fax

Practice location:
  • Phone: 305-695-0644
  • Fax: 305-695-0662
Mailing address:
  • Phone: 305-695-0644
  • Fax: 305-695-0622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3209
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: