Healthcare Provider Details

I. General information

NPI: 1609198589
Provider Name (Legal Business Name): MUSTAFA ANESTHESIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2010
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 S HELIOTROPE AVE
MONROVIA CA
91016-2914
US

IV. Provider business mailing address

PO BOX 4259
CERRITOS CA
90703-4259
US

V. Phone/Fax

Practice location:
  • Phone: 562-407-2080
  • Fax:
Mailing address:
  • Phone: 562-407-2080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberC53242
License Number StateCA

VIII. Authorized Official

Name: JAMAL MUSTAFA
Title or Position: PRESIDENT
Credential: MD
Phone: 562-407-2080