Healthcare Provider Details

I. General information

NPI: 1306474945
Provider Name (Legal Business Name): MUSTAFA FIKRI ALKHOULI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 COYLE AVE SUITE 212
CARMICHAEL CA
95608
US

IV. Provider business mailing address

6620 COYLE AVE
CARMICHAEL CA
95608
US

V. Phone/Fax

Practice location:
  • Phone: 916-536-9455
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number19346
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: