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General NPI Number Information
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NPI Number | 1205116399
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Entity Type | Organization
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Legal Business Name | ROYA GHADIMI, M.D., P.A.
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Dates
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Enumeration Date | 08/22/2011
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Last Update Date | 12/20/2011
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Provider Practice Location Address
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Address Line | 1415 PANTHER LN SUITE 322
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City | NAPLES
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State | FL
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Zip | 34109-7874
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Country | US
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Telephone | 239-593-6120
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Fax |
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Provider Business Mailing Address
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Address Line | 1415 PANTHER LN SUITE 322
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City | NAPLES
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State | FL
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Zip | 34109-7874
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Country | US
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Telephone | 239-593-6120
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROYA GHADIMI
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Credential | MD
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Telephone | 239-593-6120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number | ME107176
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License Number State | FL
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