Doctor Name: | MOUSTAFA BANNA |
NPI Number: | 1003009861 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | MT186538 |
Business Practice Address: | 5859 W. Talavi Blvd Suite 100 Glendale, AZ - 853061869 |
Business Phone Number: | 6022987777 |
Business Fax Number: | 6239306060 |
Mailing Address: | 5859 W. Talavi Blvd, Suite 100 GLENDALE |
State: | AZ |
Postal Code: | 853061869 |
Phone Number: | 6022987777 |
Fax Number: | 6239306060 |
NPI Enumeration Date: | 08/23/2007 |
NPI Last Update Date: | 11/16/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | MT186538 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | PA |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |