Provider Demographics
NPI:1679895825
Name:FORADI, MEHRAFROUZ RASSAPOUR (AP,DOM)
Entity type:Individual
Prefix:
First Name:MEHRAFROUZ
Middle Name:RASSAPOUR
Last Name:FORADI
Suffix:
Gender:F
Credentials:AP,DOM
Other - Prefix:
Other - First Name:LADAN
Other - Middle Name:
Other - Last Name:FORADI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1151 BLACKWOOD AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4519
Mailing Address - Country:US
Mailing Address - Phone:321-662-2632
Mailing Address - Fax:407-253-1470
Practice Address - Street 1:1151 BLACKWOOD AVE STE 110
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4519
Practice Address - Country:US
Practice Address - Phone:321-662-2632
Practice Address - Fax:407-253-1470
Is Sole Proprietor?:No
Enumeration Date:2010-02-15
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2794171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist