Healthcare Provider Details

I. General information

NPI: 1952261414
Provider Name (Legal Business Name): ELTAYEB MUSSA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 11/17/2025
Certification Date: 11/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 SABLEWOOD DR APT G141
BAKERSFIELD CA
93314-4329
US

IV. Provider business mailing address

2600 SABLEWOOD DR APT G141
BAKERSFIELD CA
93314-4329
US

V. Phone/Fax

Practice location:
  • Phone: 661-587-0838
  • Fax:
Mailing address:
  • Phone: 661-587-0838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH91776
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: