Provider Demographics
NPI:1043410434
Name:EGHBAL, MANOUCHEHR (AP)
Entity Type:Individual
Prefix:
First Name:MANOUCHEHR
Middle Name:
Last Name:EGHBAL
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10231 E COLONIAL DR STE C
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-4331
Mailing Address - Country:US
Mailing Address - Phone:407-232-1757
Mailing Address - Fax:407-641-9668
Practice Address - Street 1:10231 E COLONIAL DR STE C
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-4331
Practice Address - Country:US
Practice Address - Phone:407-232-1757
Practice Address - Fax:407-641-9668
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2423171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist