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General NPI Number Information
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NPI Number | 1457410680
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Entity Type | Organization
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Legal Business Name | VARTGEZ MANSOURIAN MD PA
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 10/13/2011
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Provider Practice Location Address
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Address Line | 951 NW 13TH ST SUITE 2B
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City | BOCA RATON
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State | FL
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Zip | 33486-2359
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Country | US
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Telephone | 561-750-7110
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Fax | 561-750-7151
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Provider Business Mailing Address
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Address Line | 951 NW 13TH ST SUITE 2B
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City | BOCA RATON
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State | FL
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Zip | 33486-2359
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Country | US
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Telephone | 561-750-7110
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Fax | 561-750-7151
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Authorized Official
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Title or Position | OWNER
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Name | DR. VARTGEZ KENARAKY MANSOURIAN
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Credential | M.D.
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Telephone | 561-750-7110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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