Provider Demographics
NPI:1780670836
Name:HAMDY, MOSTAFA A (MD)
Entity Type:Individual
Prefix:
First Name:MOSTAFA
Middle Name:A
Last Name:HAMDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 S IMPERIAL AVE
Mailing Address - Street 2:NUMBER 8
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-4242
Mailing Address - Country:US
Mailing Address - Phone:760-353-5000
Mailing Address - Fax:760-370-3229
Practice Address - Street 1:605 W H ST
Practice Address - Street 2:110
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-4200
Practice Address - Country:US
Practice Address - Phone:760-344-7976
Practice Address - Fax:760-344-7106
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43951207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A439510Medicaid
A29755Medicare UPIN
CAA43951Medicare ID - Type Unspecified