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General NPI Number Information
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NPI Number | 1831431857
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Entity Type | Organization
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Legal Business Name | SOLMAZ BEHTASH, D.O., LLC
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Dates
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Enumeration Date | 03/18/2013
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Last Update Date | 04/05/2013
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Provider Practice Location Address
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Address Line | 126 PROSPECT ST #101
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City | PAWTUCKET
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State | RI
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Zip | 02860-4476
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Country | US
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Telephone | 401-365-4060
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Fax |
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Provider Business Mailing Address
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Address Line | 126 PROSPECT ST #101
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City | PAWTUCKET
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State | RI
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Zip | 02860-4476
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Country | US
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Telephone | 401-365-4060
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SOLMAZ BEHTASH
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Credential | D.O.
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Telephone | 401-365-4060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | DO 630
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License Number State | RI
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