Provider Demographics
NPI:1417159682
Name:MOUSAVI, FATEMEH RHANA (MD)
Entity Type:Individual
Prefix:
First Name:FATEMEH
Middle Name:RHANA
Last Name:MOUSAVI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10425 AVENIDA DEL RIO
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-2417
Mailing Address - Country:US
Mailing Address - Phone:561-306-4906
Mailing Address - Fax:561-270-0391
Practice Address - Street 1:5361 NW 33RD AVE
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-6313
Practice Address - Country:US
Practice Address - Phone:954-717-0300
Practice Address - Fax:561-270-0391
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94764207ZP0101X, 207ZP0102X, 207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology