Healthcare Provider Details

I. General information

NPI: 1033068598
Provider Name (Legal Business Name): FATIN MUSTAFA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4615 SOUTHWEST FWY STE 900
HOUSTON TX
77027-7191
US

IV. Provider business mailing address

PO BOX 57845
WEBSTER TX
77598-7845
US

V. Phone/Fax

Practice location:
  • Phone: 346-250-5650
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1135618
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: