MEDICARE: IBRAHIM MUSTAFA

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	1223G0001X	General Practice Dentistry	112921	CA

General Provider Information

NPI Number	:	1134058993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IBRAHIM MUSTAFA

Provider Business Mailing Address
First Line	:	2450 SAWGRASS ST
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92019-4552
Country	:	US
Telephone Number	:	248-346-5442
Fax Number	:

Provider Business Practice Location Address
First Line	:	2450 SAWGRASS ST
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92019-4552
Country	:	US
Telephone Number	:	248-346-5442
Fax Number	:

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

Provider Enumeration Date	:	05/18/2026
Last Update Date	:	05/18/2026

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Directions to “ IBRAHIM MUSTAFA ” Practice Location

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