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General NPI Number Information
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NPI Number | 1710984679
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Entity Type | Individual
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Provider Name | HASAN M. MOUSLI MD
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Gender | Male
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Dates
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Enumeration Date | 07/06/2005
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Last Update Date | 09/20/2012
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Provider Practice Location Address
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Address Line | 1120 CARLTON AVE SUITE 1300
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City | LAKE WALES
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State | FL
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Zip | 33853-4348
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Country | US
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Telephone | 863-676-6386
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Fax | 863-676-6452
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Provider Business Mailing Address
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Address Line | 1120 CARLTON AVE SUITE 1300
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City | LAKE WALES
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State | FL
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Zip | 33853-4348
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Country | US
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Telephone | 863-676-6386
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Fax | 863-676-6452
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | ME97722
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License Number State | FL
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