MEDICARE: HADEAL MOUSTAFA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	3266	CA

General Provider Information

NPI Number	:	1083073258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HADEAL MOUSTAFA

Provider Business Mailing Address
First Line	:	17216 SATICOY ST
Second Line	:	141
City	:	VAN NUYS
State	:	CA
Zip	:	91406-2103
Country	:	US
Telephone Number	:	818-497-3012
Fax Number	:

Provider Business Practice Location Address
First Line	:	5775 E LOS ANGELES AVE
Second Line	:	230
City	:	SIMI VALLEY
State	:	CA
Zip	:	93063-5213
Country	:	US
Telephone Number	:	818-497-3012
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2016
Last Update Date	:	02/16/2016

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Directions to “ HADEAL MOUSTAFA ” Practice Location

Language	Start Address	Practice Location

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