Provider Demographics
NPI:1023576519
Name:ELHASSANI, MOSTAFA
Entity Type:Individual
Prefix:MR
First Name:MOSTAFA
Middle Name:
Last Name:ELHASSANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 CIRCUIT LN UNIT F
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-2990
Mailing Address - Country:US
Mailing Address - Phone:757-637-5944
Mailing Address - Fax:
Practice Address - Street 1:365 CIRCUIT LN UNIT F
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-2990
Practice Address - Country:US
Practice Address - Phone:757-637-5944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT61733811347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle