Healthcare Provider Details

I. General information

NPI: 1992238414
Provider Name (Legal Business Name): MOSTAFA MAITA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 S MILL AVE STE 101
TEMPE AZ
85282-2106
US

IV. Provider business mailing address

2121 S MILL AVE STE 101
TEMPE AZ
85282-2106
US

V. Phone/Fax

Practice location:
  • Phone: 602-853-4004
  • Fax:
Mailing address:
  • Phone: 602-853-4004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number008885
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberT9177
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number008885
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: