Provider Demographics
NPI:1457410680
Name:VARTGEZ MANSOURIAN MD PA
Entity Type:Organization
Organization Name:VARTGEZ MANSOURIAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VARTGEZ
Authorized Official - Middle Name:KENARAKY
Authorized Official - Last Name:MANSOURIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-750-7110
Mailing Address - Street 1:951 NW 13TH ST
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2359
Mailing Address - Country:US
Mailing Address - Phone:561-750-7110
Mailing Address - Fax:561-750-7151
Practice Address - Street 1:951 NW 13TH ST
Practice Address - Street 2:SUITE 2B
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2359
Practice Address - Country:US
Practice Address - Phone:561-750-7110
Practice Address - Fax:561-750-7151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0551Medicare PIN