Provider Demographics
NPI:1235671207
Name:ALHAQQAN, DALAL MAMA (MD)
Entity Type:Individual
Prefix:DR
First Name:DALAL
Middle Name:MAMA
Last Name:ALHAQQAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 NW 12 AVENUE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136
Mailing Address - Country:US
Mailing Address - Phone:305-585-5215
Mailing Address - Fax:305-585-8137
Practice Address - Street 1:1611 NW 12 AVENUE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136
Practice Address - Country:US
Practice Address - Phone:305-585-5215
Practice Address - Fax:305-585-8137
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-08
Last Update Date:2022-07-21
Deactivation Date:2017-06-20
Deactivation Code:
Reactivation Date:2017-07-19
Provider Licenses
StateLicense IDTaxonomies
FLTRN23862390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program