Healthcare Provider Details

I. General information

NPI: 1366940264
Provider Name (Legal Business Name): BASHAR EGHNAIM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 N KENDALL DR
MIAMI FL
33176-2197
US

IV. Provider business mailing address

8201 SW 122ND AVE
MIAMI FL
33183-2601
US

V. Phone/Fax

Practice location:
  • Phone: 786-596-3621
  • Fax: 786-596-2841
Mailing address:
  • Phone: 786-354-3076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA1004
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: