Healthcare Provider Details

I. General information

NPI: 1093163560
Provider Name (Legal Business Name): MUSTAFA REHMANI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2016
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 E GREEN ST STE 306
PASADENA CA
91106-2401
US

IV. Provider business mailing address

556 S FAIR OAKS AVE STE 101-233
PASADENA CA
91105-2656
US

V. Phone/Fax

Practice location:
  • Phone: 626-793-0141
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20A18419
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: