Provider Demographics
NPI:1790970283
Name:HOSSAINI, MAHINALSADAT (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHINALSADAT
Middle Name:
Last Name:HOSSAINI
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 1:4201 INTERWAY PL
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-5668
Mailing Address - Country:US
Mailing Address - Phone:817-652-9192
Mailing Address - Fax:817-652-9238
Practice Address - Street 1:4201 INTERWAY PL
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-5668
Practice Address - Country:US
Practice Address - Phone:817-652-9192
Practice Address - Fax:817-652-9238
Is Sole Proprietor?:No
Enumeration Date:2007-09-08
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8193208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX216984901Medicaid