Provider Demographics
NPI:1245538503
Name:MAHBOOBEH GOLTAPEH , M.D., PA
Entity type:Organization
Organization Name:MAHBOOBEH GOLTAPEH , M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHBOOBEH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLTAPEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:3058-549-8768
Mailing Address - Street 1:3661 S MIAMI AVE
Mailing Address - Street 2:904
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4236
Mailing Address - Country:US
Mailing Address - Phone:305-854-9878
Mailing Address - Fax:
Practice Address - Street 1:3661 S MIAMI AVE
Practice Address - Street 2:904
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4236
Practice Address - Country:US
Practice Address - Phone:305-854-9878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 50341261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE56656Medicare UPIN