Provider Demographics
NPI:1194946780
Name:RASSAPOUR, SAMIRA (AP,)
Entity type:Individual
Prefix:DR
First Name:SAMIRA
Middle Name:
Last Name:RASSAPOUR
Suffix:
Gender:F
Credentials:AP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 NORTH BLACKWOOD AVE #110
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761
Mailing Address - Country:US
Mailing Address - Phone:407-253-1450
Mailing Address - Fax:407-253-1470
Practice Address - Street 1:1151 NORTH BLACKWOOD AVE #110
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761
Practice Address - Country:US
Practice Address - Phone:407-253-1450
Practice Address - Fax:407-253-1470
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1579174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC0993OtherBCBS