Healthcare Provider Details

I. General information

NPI: 1811180920
Provider Name (Legal Business Name): NASSIM ROUHANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 06/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 BRUCEDALE CRESCENT
TORONTO ONTARIO
M2K2C6
CA

IV. Provider business mailing address

43 BRUCEDALE CRESCENT
TORONTO ONTARIO
M2K2C6
CA

V. Phone/Fax

Practice location:
  • Phone: 416-733-9082
  • Fax:
Mailing address:
  • Phone: 416-733-9082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberN/A
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: