Healthcare Provider Details

I. General information

NPI: 1225579360
Provider Name (Legal Business Name): MUSTAFA MAJEED ALOKAILI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2017
Last Update Date: 03/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 E BRADLEY AVE #124
EL CAJON CA
92021-2927
US

IV. Provider business mailing address

325 E BRADLEY AVE #124
EL CAJON CA
92021-2927
US

V. Phone/Fax

Practice location:
  • Phone: 619-201-0686
  • Fax:
Mailing address:
  • Phone: 619-201-0686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number017-005084
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: