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General NPI Number Information
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NPI Number | 1811255193
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Entity Type | Individual
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Provider Name | YASMIN POUSTCHI MALI MD
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Gender | Female
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Dates
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Enumeration Date | 04/24/2012
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Last Update Date | 04/05/2018
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Provider Practice Location Address
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Address Line | 15901 BASS RD STE 108
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City | FORT MYERS
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State | FL
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Zip | 33908-3838
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Country | US
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Telephone | 239-343-6050
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Fax | 239-343-6051
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Provider Business Mailing Address
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Address Line | PO BOX 5192
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City | SARASOTA
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State | FL
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Zip | 34277-5192
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Country | US
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Telephone | 848-219-0247
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 2016-00301
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME132900
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License Number State | FL
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