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General NPI Number Information
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NPI Number | 1164419834
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Entity Type | Individual
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Provider Name | MOUSTAFA M. AOUTHMANY MD
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Gender | Male
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Dates
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Enumeration Date | 09/29/2005
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Last Update Date | 03/01/2022
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Provider Practice Location Address
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Address Line | 9300 VALLEY CHILDRENS PL
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City | MADERA
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State | CA
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Zip | 93636
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Country | US
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Telephone | 559-353-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 250 N SHADELAND AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-4959
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 35065614
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 01074192A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | C145911
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License Number State | CA
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