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NPI Code Detail

MEDICARE: VIDA FALAHATIAN

MEDICARE: VIDA FALAHATIAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1104386200
Entity Type Code : Individual
Provider Name (Legal Business Name) : VIDA FALAHATIAN
Provider Business Mailing Address
First Line : 1611 NW 12TH AVE
Second Line :
City : MIAMI
State : FL
Zip : 33136-1005
Country : US
Telephone Number : 240-898-6816
Fax Number :
Provider Business Practice Location Address
First Line : 1611 NW 12TH AVE
Second Line :
City : MIAMI
State : FL
Zip : 33136-1005
Country : US
Telephone Number : 305-585-1111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2019
Last Update Date : 05/06/2019

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Directions to “ VIDA FALAHATIAN ” Practice Location

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