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General NPI Number Information
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NPI Number | 1366486854
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Entity Type | Individual
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Provider Name | JAMAL DAWAN MUSTAFA MD
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Gender | Male
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 08/06/2018
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Provider Practice Location Address
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Address Line | 323 S HELIOTROPE AVE
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City | MONROVIA
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State | CA
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Zip | 91016
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Country | US
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Telephone | 626-408-9800
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Fax |
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Provider Business Mailing Address
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Address Line | 14120 ALONDRA BLVD SUITE C
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City | SANTA FE SPRINGS
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State | CA
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Zip | 90670-5820
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Country | US
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Telephone | 562-407-2080
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Fax | 562-407-2082
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD20030707
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | C52342
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License Number State | CA
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