Healthcare Provider Details

I. General information

NPI: 1740980473
Provider Name (Legal Business Name): MOSTAFA MOHAMED SOLIMAN GAMALELDIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 11/25/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 E MANNING AVE
PARLIER CA
93648-2668
US

IV. Provider business mailing address

429 E MANNING AVE
PARLIER CA
93648-2668
US

V. Phone/Fax

Practice location:
  • Phone: 559-646-6618
  • Fax: 559-646-6780
Mailing address:
  • Phone: 559-646-6618
  • Fax: 559-646-6780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number40119
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number111027
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: