Healthcare Provider Details

I. General information

NPI: 1285939991
Provider Name (Legal Business Name): FAIZE PATRICIA MUSTAFA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: FAIZE PATRICIA MUSTAFA MD

II. Dates (important events)

Enumeration Date: 01/11/2011
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7117 BROCKTON AVE
RIVERSIDE CA
92506-2658
US

IV. Provider business mailing address

7117 BROCKTON AVE
RIVERSIDE CA
92506-2658
US

V. Phone/Fax

Practice location:
  • Phone: 951-782-3638
  • Fax: 951-784-3257
Mailing address:
  • Phone: 951-782-3638
  • Fax: 951-784-3257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA112589
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: