Healthcare Provider Details

I. General information

NPI: 1508482084
Provider Name (Legal Business Name): FARRAH ALEEMA RAJAB MD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20801 NW 2ND AVE
MIAMI FL
33169-2103
US

IV. Provider business mailing address

20801 NW 2ND AVE
MIAMI FL
33169-2103
US

V. Phone/Fax

Practice location:
  • Phone: 305-653-1770
  • Fax: 786-725-3453
Mailing address:
  • Phone: 305-653-1770
  • Fax: 786-725-3453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4351046594
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME161317
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: