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General NPI Number Information
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NPI Number | 1497788103
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Entity Type | Individual
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Provider Name | ROSTISLAV IGNATOV M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 08/26/2024
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Provider Practice Location Address
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Address Line | 1325 N HAVERHILL RD
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City | WEST PALM BEACH
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State | FL
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Zip | 33417-5914
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Country | US
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Telephone | 305-924-6593
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2261
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City | WEST PALM BEACH
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State | FL
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Zip | 33402-2261
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Country | US
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Telephone | 305-924-6593
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number | ME93056
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | ME93056
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME93056
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License Number State | FL
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