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General NPI Number Information
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NPI Number | 1912195918
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Entity Type | Individual
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Provider Name | NILOUFAR MOBASHERY MD
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Gender | Female
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Dates
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Enumeration Date | 10/04/2007
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Last Update Date | 10/04/2007
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Provider Practice Location Address
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Address Line | 50 PEQUOT AVE MS 6025-B3125
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City | NEW LONDON
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State | CT
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Zip | 06320-5410
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Country | US
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Telephone | 860-732-1033
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Fax |
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Provider Business Mailing Address
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Address Line | 20 DENNISON RD
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City | ESSEX
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State | CT
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Zip | 06426-1350
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Country | US
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Telephone | 408-705-7193
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | A79219
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License Number State | CA
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