Provider Demographics
NPI:1396404489
Name:MOSTOFO, HASAN S (NMD)
Entity Type:Individual
Prefix:DR
First Name:HASAN
Middle Name:S
Last Name:MOSTOFO
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9829 S 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-9523
Mailing Address - Country:US
Mailing Address - Phone:480-285-4135
Mailing Address - Fax:
Practice Address - Street 1:9829 S 20TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-9523
Practice Address - Country:US
Practice Address - Phone:480-285-4135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21-1672175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath