Provider Demographics
NPI:1740980473
Name:GAMALELDIN, MOSTAFA MOHAMED SOLIMAN
Entity type:Individual
Prefix:
First Name:MOSTAFA
Middle Name:MOHAMED SOLIMAN
Last Name:GAMALELDIN
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 1:429 E MANNING AVE
Mailing Address - Street 2:
Mailing Address - City:PARLIER
Mailing Address - State:CA
Mailing Address - Zip Code:93648-2668
Mailing Address - Country:US
Mailing Address - Phone:559-646-6618
Mailing Address - Fax:559-646-6780
Practice Address - Street 1:429 E MANNING AVE
Practice Address - Street 2:
Practice Address - City:PARLIER
Practice Address - State:CA
Practice Address - Zip Code:93648-2668
Practice Address - Country:US
Practice Address - Phone:559-646-6618
Practice Address - Fax:559-646-6780
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40119122300000X
390200000X
CA111027122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program