MEDICARE: SUMMER MOSTAFA DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	343788	LA

General Provider Information

NPI Number	:	1053015214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUMMER MOSTAFA DO

Provider Business Mailing Address
First Line	:	209 SAGEMOOR CT
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95678-3435
Country	:	US
Telephone Number	:	916-380-2118
Fax Number	:

Provider Business Practice Location Address
First Line	:	3201 GENERAL DEGAULLE DR
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70114-6756
Country	:	US
Telephone Number	:	504-354-2103
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2023
Last Update Date	:	06/23/2025

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