Healthcare Provider Details

I. General information

NPI: 1881120913
Provider Name (Legal Business Name): MUSTAFA MONIS PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2017
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5939 BABCOCK RD STE 112
SAN ANTONIO TX
78240-2199
US

IV. Provider business mailing address

8522 BROADWAY STE 216
SAN ANTONIO TX
78217-6456
US

V. Phone/Fax

Practice location:
  • Phone: 210-874-5260
  • Fax: 210-864-4838
Mailing address:
  • Phone: 210-874-5260
  • Fax: 210-864-4838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA11292
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: