Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 5461 | AZ |
Y | 111NI0900X | Internist | 5461 | AZ |
NPI | 1003098161 |
---|---|
Provider Name | Moustafa I Hazin |
First Address | Los Angeles, CA 90074-6765 |
Second Address | Phoenix, AZ 85013-4224 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2007 |
Last Update Date | 17/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
529073 | (05) | AZ |