MEDICARE: HEBA MOSTAFA EL-HADDAD

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1215810684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEBA MOSTAFA EL-HADDAD

Provider Business Mailing Address
First Line	:	3033 WILLIAMS RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95128-3340
Country	:	US
Telephone Number	:	320-427-4748
Fax Number	:

Provider Business Practice Location Address
First Line	:	3003 SCOTT BLVD
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95054-3316
Country	:	US
Telephone Number	:	855-554-2545
Fax Number	:

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

Provider Enumeration Date	:	07/31/2025
Last Update Date	:	07/31/2025

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