Healthcare Provider Details

I. General information

NPI: 1821155730
Provider Name (Legal Business Name): MOJDEH NAGHASHPOUR M.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 08/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12902 USF MAGNOLIA DR MCC-LAB
TAMPA FL
33612-9416
US

IV. Provider business mailing address

12701 COMMONWEALTH DR
FORT MYERS FL
33913-8626
US

V. Phone/Fax

Practice location:
  • Phone: 813-745-3914
  • Fax:
Mailing address:
  • Phone: 239-768-0711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberME105281
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: