Healthcare Provider Details

I. General information

NPI: 1699123786
Provider Name (Legal Business Name): HOSSEIN GOLABBAKHSH CAA, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2016
Last Update Date: 05/25/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 AVENUE F NE
WINTER HAVEN FL
33881-4131
US

IV. Provider business mailing address

111 W CENTRAL AVE UNIT 1828
WINTER HAVEN FL
33882-7075
US

V. Phone/Fax

Practice location:
  • Phone: 832-373-1134
  • Fax:
Mailing address:
  • Phone: 832-373-1134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: