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General NPI Number Information
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NPI Number | 1528350303
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Entity Type | Individual
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Provider Name | BAHAREH HASSANZADEH M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/11/2011
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Last Update Date | 09/13/2021
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Provider Practice Location Address
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Address Line | 392 RINEHART RD STE 3040
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City | LAKE MARY
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State | FL
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Zip | 32746-2548
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Country | US
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Telephone | 321-842-2363
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Fax | 321-842-2370
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Provider Business Mailing Address
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Address Line | 392 RINEHART RD STE 3040
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City | LAKE MARY
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State | FL
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Zip | 32746-2548
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Country | US
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Telephone | 321-842-2363
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Fax | 321-842-2370
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME119367
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 036.138849
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | C159706
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | ME119367
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License Number State | FL
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