Healthcare Provider Details

I. General information

NPI: 1942532213
Provider Name (Legal Business Name): CHRISTINA FURST NAMVAR D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2010
Last Update Date: 11/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 WELLNESS WAY SUITE 204
SEBASTIAN FL
32958
US

IV. Provider business mailing address

P.O. BOX 1209
VERO BEACH FL
32961
US

V. Phone/Fax

Practice location:
  • Phone: 772-567-6340
  • Fax: 772-567-3564
Mailing address:
  • Phone: 772-567-6340
  • Fax: 772-567-3564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS9600
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: