Healthcare Provider Details

I. General information

NPI: 1902436058
Provider Name (Legal Business Name): MUSARRAT KHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14736 WILLOW GROVE PL
MORENO VALLEY CA
92555-5746
US

IV. Provider business mailing address

14736 WILLOW GROVE PL
MORENO VALLEY CA
92555-5746
US

V. Phone/Fax

Practice location:
  • Phone: 909-282-2316
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: