Provider Demographics
NPI:1689995250
Name:POURMASIHA, NILOUFAR (DO)
Entity Type:Individual
Prefix:
First Name:NILOUFAR
Middle Name:
Last Name:POURMASIHA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8995 WATERCREST CIR E
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-2851
Mailing Address - Country:US
Mailing Address - Phone:305-310-0843
Mailing Address - Fax:
Practice Address - Street 1:8995 WATERCREST CIR E
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33076
Practice Address - Country:US
Practice Address - Phone:305-310-0843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS12637207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0236942Medicaid
NJ0236942Medicaid
NJ189968A01Medicare PIN
NJ189968DBHMedicare PIN