Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0401X | Internist - Addiction Medicine | 90235 | GA |
Y | 208D00000X | General Practice Physician | 90235 | GA |
NPI | 1851904601 |
---|---|
Provider Name | Mobashir Hosameddin |
First Address | South Miami, FL 33143-4701 |
Second Address | South Miami, FL 33143-4701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2020 |
Last Update Date | 05/12/2021 |