Healthcare Provider Details

I. General information

NPI: 1649271925
Provider Name (Legal Business Name): SEYED-MOJTABA GASHTI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 11/03/2024
Certification Date: 11/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1447 MEDICAL PARK BLVD STE 405
WELLINGTON FL
33414-3183
US

IV. Provider business mailing address

21966 CANADENSIS CIR
BOCA RATON FL
33428-3911
US

V. Phone/Fax

Practice location:
  • Phone: 561-767-8342
  • Fax:
Mailing address:
  • Phone: 410-409-4562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number239940
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberH0062393
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOS14009
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MB06746000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: