Provider Demographics
NPI:1154765667
Name:RASOULI, GOLTA (MD)
Entity type:Individual
Prefix:DR
First Name:GOLTA
Middle Name:
Last Name:RASOULI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2389 E VENICE AVE UNIT 510
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-2465
Mailing Address - Country:US
Mailing Address - Phone:941-529-0070
Mailing Address - Fax:941-529-0539
Practice Address - Street 1:395 COMMERCIAL CT STE C
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-1651
Practice Address - Country:US
Practice Address - Phone:941-529-0070
Practice Address - Fax:941-529-0539
Is Sole Proprietor?:No
Enumeration Date:2013-04-26
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME145594207N00000X, 207R00000X, 202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine