Individual
ADEL BASHIRIMOGHADDAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1600 SW ARCHER RD, GAINESVILLE, FL 32610-2616
(352) 273-8610
(352) 273-8612
Mailing address
PO BOX 100254, GAINESVILLE, FL 32610-0254
(352) 273-8610
(352) 273-8612
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN11017560
FL
390200000X
Student in an Organized Health Care Education/Training Program
RN9413485
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113461900
—
FL
Enumeration date
06/30/2021
Last updated
06/13/2023
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