Provider Demographics
NPI:1104121870
Name:ZOLFAGHARI, NOOSHIN (DPM)
Entity type:Individual
Prefix:
First Name:NOOSHIN
Middle Name:
Last Name:ZOLFAGHARI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14730 SW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-6107
Mailing Address - Country:US
Mailing Address - Phone:954-899-0520
Mailing Address - Fax:954-437-3468
Practice Address - Street 1:2699 STIRLING RD
Practice Address - Street 2:SUITE A301
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-6517
Practice Address - Country:US
Practice Address - Phone:954-278-3890
Practice Address - Fax:954-251-1470
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3442213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004505600Medicaid
FL6504NOtherBCBS
FLFU268ZMedicare UPIN