Provider Demographics
NPI:1992710347
Name:MIHTAR, HUSSAM (MD)
Entity type:Individual
Prefix:
First Name:HUSSAM
Middle Name:
Last Name:MIHTAR
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 1:8899 UNIVERSITY CENTER LN STE 170
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-1009
Mailing Address - Country:US
Mailing Address - Phone:858-453-4441
Mailing Address - Fax:619-583-2729
Practice Address - Street 1:8899 UNIVERSITY CENTER LN STE 170
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-1009
Practice Address - Country:US
Practice Address - Phone:858-453-4441
Practice Address - Fax:619-583-2729
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0517052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF77952Medicare UPIN
CAA51705Medicare ID - Type Unspecified