Healthcare Provider Details

I. General information

NPI: 1043534951
Provider Name (Legal Business Name): MORTEZA NADJAFI, M.D.,P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2010
Last Update Date: 03/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 N MAGNOLIA AVE
ORLANDO FL
32803-3809
US

IV. Provider business mailing address

736 N MAGNOLIA AVE
ORLANDO FL
32803-3809
US

V. Phone/Fax

Practice location:
  • Phone: 407-423-7149
  • Fax: 407-422-0470
Mailing address:
  • Phone: 407-423-7149
  • Fax: 407-422-0470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MORTEZA NADJAFI
Title or Position: CEO
Credential: M.D.
Phone: 407-423-7149