Healthcare Provider Details

I. General information

NPI: 1487440392
Provider Name (Legal Business Name): SEYED MORTEZA MOUSAVI HASSANZADEH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2025
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 E ROLLINS ST 6TH FLOOR
ORLANDO FL
32808-5519
US

IV. Provider business mailing address

5475 E SUNRISE RIDGE PL
TUCSON AZ
85718-7066
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-6729
  • Fax:
Mailing address:
  • Phone: 781-921-4929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN45085
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: