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General NPI Number Information
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NPI Number | 1932617669
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Entity Type | Individual
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Provider Name | MASTORA ALI FNP
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Gender | Female
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Dates
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Enumeration Date | 01/16/2018
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Last Update Date | 08/19/2020
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Provider Practice Location Address
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Address Line | 2425 ALHAMBRA BLVD
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City | SACRAMENTO
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State | CA
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Zip | 95817-1110
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Country | US
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Telephone | 916-737-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 1673 DIAMOND WOODS CIR
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City | ROSEVILLE
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State | CA
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Zip | 95747-4601
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95007021
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License Number State | CA
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