Healthcare Provider Details

I. General information

NPI: 1629408893
Provider Name (Legal Business Name): MINA MORADI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2013
Last Update Date: 01/31/2025
Certification Date: 12/31/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4645 PALMBROOKE CIR
WEST PALM BEACH FL
33417-7532
US

IV. Provider business mailing address

4645 PALMBROOKE CIR
WEST PALM BEACH FL
33417-7532
US

V. Phone/Fax

Practice location:
  • Phone: 561-460-9293
  • Fax:
Mailing address:
  • Phone: 561-460-9293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2279H0200X
TaxonomyHome Health Registered Respiratory Therapist
License NumberRT12026
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRT12026
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: