Provider Demographics
NPI:1083485668
Name:ELDIN, MOSTAFA
Entity Type:Individual
Prefix:
First Name:MOSTAFA
Middle Name:
Last Name:ELDIN
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 1:3870 KINGSBARNS DR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-6359
Mailing Address - Country:US
Mailing Address - Phone:916-835-3347
Mailing Address - Fax:
Practice Address - Street 1:3870 KINGSBARNS DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-6359
Practice Address - Country:US
Practice Address - Phone:916-835-3347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker