Healthcare Provider Details

I. General information

NPI: 1063464709
Provider Name (Legal Business Name): ROMILA MUSHTAQ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 S AVENUE A
YUMA AZ
85364-7127
US

IV. Provider business mailing address

7600 N 16TH ST SUITE 150
PHOENIX AZ
85020-4431
US

V. Phone/Fax

Practice location:
  • Phone: 928-726-6335
  • Fax: 928-726-6338
Mailing address:
  • Phone: 602-395-0718
  • Fax: 602-277-8146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number48711
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: