Healthcare Provider Details

I. General information

NPI: 1447176789
Provider Name (Legal Business Name): MUSTAFA MALE (M) SEMIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 CARLISLE BLVD NE STE 225
ALBUQUERQUE NM
87110-1664
US

IV. Provider business mailing address

3200 CARLISLE BLVD NE STE 225
ALBUQUERQUE NM
87110-1664
US

V. Phone/Fax

Practice location:
  • Phone: 503-737-7327
  • Fax: 505-293-0617
Mailing address:
  • Phone: 503-737-7327
  • Fax: 505-293-0617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: