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General NPI Number Information
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NPI Number | 1780278655
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Entity Type | Individual
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Provider Name | HASAN MOHAMMED MUSTAFA
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Gender | Male
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Dates
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Enumeration Date | 02/22/2021
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Last Update Date | 02/23/2021
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Provider Practice Location Address
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Address Line | 286 EUCLID AVE STE 201
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City | SAN DIEGO
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State | CA
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Zip | 92114-3612
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Country | US
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Telephone | 949-800-9524
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Fax |
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Provider Business Mailing Address
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Address Line | 3655 CASS ELIZABETH RD
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City | WATERFORD
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State | MI
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Zip | 48328-4531
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Country | US
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Telephone | 248-346-5442
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 106025
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License Number State | CA
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