Provider Demographics
NPI:1497917637
Name:HOSEIN, MARCEL A
Entity Type:Individual
Prefix:MR
First Name:MARCEL
Middle Name:A
Last Name:HOSEIN
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 1:4414 SW ABOVO ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-6502
Mailing Address - Country:US
Mailing Address - Phone:772-342-8711
Mailing Address - Fax:772-805-8195
Practice Address - Street 1:4414 SW ABOVO ST
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-6502
Practice Address - Country:US
Practice Address - Phone:772-342-8711
Practice Address - Fax:772-805-8195
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL693720996Medicaid
FL693720998Medicaid