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General NPI Number Information
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NPI Number | 1326307919
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Entity Type | Organization
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Legal Business Name | DR. RAHAT FADERANI, DO, MPH, PA
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Dates
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Enumeration Date | 05/16/2012
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Last Update Date | 05/16/2012
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Provider Practice Location Address
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Address Line | 5913 S CONGRESS AVE
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City | LAKE WORTH
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State | FL
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Zip | 33462-1303
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Country | US
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Telephone | 561-543-8888
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Fax | 888-663-8123
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Provider Business Mailing Address
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Address Line | PO BOX 3821
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City | LANTANA
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State | FL
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Zip | 33465-3821
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Country | US
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Telephone | 561-543-8888
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Fax | 888-663-8123
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Authorized Official
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Title or Position | DOCTOR, OWNER
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Name | DR. RAHAT FADERANI
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Credential | DO
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Telephone | 561-543-8888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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