Healthcare Provider Details

I. General information

NPI: 1215810684
Provider Name (Legal Business Name): HEBA MOSTAFA EL-HADDAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2025
Last Update Date: 07/31/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 SCOTT BLVD
SANTA CLARA CA
95054-3316
US

IV. Provider business mailing address

3033 WILLIAMS RD
SAN JOSE CA
95128-3340
US

V. Phone/Fax

Practice location:
  • Phone: 855-554-2545
  • Fax:
Mailing address:
  • Phone: 320-427-4748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: