Healthcare Provider Details

I. General information

NPI: 1518325455
Provider Name (Legal Business Name): MUSTAFA SAFI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2016
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2434 HARRISON AVE
EUREKA CA
95501-3219
US

IV. Provider business mailing address

PO BOX 60352
SAINT LOUIS MO
63160-0352
US

V. Phone/Fax

Practice location:
  • Phone: 707-443-5685
  • Fax: 707-298-2159
Mailing address:
  • Phone: 314-362-3937
  • Fax: 314-362-3725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License NumberA164299
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: