Individual
MOHAMED AMINE STAMBOULI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CSA
Contact information
Practice address
5771 COAKLEY DR, KING GEORGE, VA 22485-2457
(202) 749-1404
Mailing address
5771 COAKLEY DR, KING GEORGE, VA 22485-2457
(202) 749-1404
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
0136000242
VA
246ZX2200X
Orthopedic Assistant
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Other
Enumeration date
10/05/2021
Last updated
10/05/2021
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