Healthcare Provider Details

I. General information

NPI: 1053015214
Provider Name (Legal Business Name): SUMMER MOSTAFA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 GENERAL DEGAULLE DR
NEW ORLEANS LA
70114-6756
US

IV. Provider business mailing address

209 SAGEMOOR CT
ROSEVILLE CA
95678-3435
US

V. Phone/Fax

Practice location:
  • Phone: 504-354-2103
  • Fax:
Mailing address:
  • Phone: 916-380-2118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number343788
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: