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General NPI Number Information
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NPI Number | 1124220967
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Entity Type | Organization
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Legal Business Name | BAHTA AND ASSOCIATES INC
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 12/06/2010
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Provider Practice Location Address
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Address Line | 10794 PINES BLVD STE 203
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-3920
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Country | US
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Telephone | 954-392-5696
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Fax | 954-392-5668
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Provider Business Mailing Address
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Address Line | PO BOX 260101
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-7101
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Country | US
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Telephone | 954-392-5696
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Fax | 954-392-5668
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. IRENE FADULLON BAHTA
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Credential | MD
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Telephone | 954-392-5696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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