Provider Demographics
NPI:1891868550
Name:MOGASBE, ABDELSALAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDELSALAM
Middle Name:
Last Name:MOGASBE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ABDELSALAM
Other - Middle Name:
Other - Last Name:MOHAMED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4030 MOORPARK AVE
Mailing Address - Street 2:SUITE 251
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-2218
Mailing Address - Country:US
Mailing Address - Phone:408-596-6278
Mailing Address - Fax:
Practice Address - Street 1:4030 MOORPARK AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117
Practice Address - Country:US
Practice Address - Phone:408-596-6278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97753208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice