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General NPI Number Information
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NPI Number | 1659795466
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL PSYCHIATRIC ASSOCIATES INC
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Dates
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Enumeration Date | 02/13/2014
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Last Update Date | 02/13/2014
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Provider Practice Location Address
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Address Line | 2545 PARTRIDGE DR
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City | WINTER HAVEN
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State | FL
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Zip | 33884-3033
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Country | US
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Telephone | 863-206-0015
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Fax |
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Provider Business Mailing Address
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Address Line | 2545 PARTRIDGE DR
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City | WINTER HAVEN
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State | FL
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Zip | 33884-3033
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | IFTIKHAR RASUL
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Credential | M.D
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Telephone | 863-206-0015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME88613
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | ME88613
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License Number State | FL
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