Provider Demographics
NPI:1790275931
Name:ALAEI TALEGHANI, POONEH
Entity Type:Individual
Prefix:
First Name:POONEH
Middle Name:
Last Name:ALAEI TALEGHANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8308 COMMERCE WAY APT 243
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1612
Mailing Address - Country:US
Mailing Address - Phone:404-643-8641
Mailing Address - Fax:
Practice Address - Street 1:2951 NW 49TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-1608
Practice Address - Country:US
Practice Address - Phone:305-712-6395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO4138213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery