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General NPI Number Information
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NPI Number | 1114017811
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Entity Type | Individual
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Provider Name | MOSTAFA EL GHISSASSI MD
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Gender | Male
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 9611 W BROWARD BLVD
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City | PLANTATION
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State | FL
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Zip | 33324-2334
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Country | US
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Telephone | 954-924-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 2995 DREW ST
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City | CLEARWATER
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State | FL
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Zip | 33759-3012
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Country | US
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Telephone | 727-281-9065
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME152727
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 226312
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License Number State | NY
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