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NPI Code Detail

MEDICARE: ALIYAH MUSTAFAA

MEDICARE: ALIYAH MUSTAFAA
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1245835669
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALIYAH MUSTAFAA
Provider Business Mailing Address
First Line : 5035 S EAST END AVE # 3605
Second Line :
City : CHICAGO
State : IL
Zip : 60615-0035
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5035 S EAST END AVE # 3605
Second Line :
City : CHICAGO
State : IL
Zip : 60615-0035
Country : US
Telephone Number : 843-343-7496
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2020
Last Update Date : 12/02/2020

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Directions to “ ALIYAH MUSTAFAA ” Practice Location

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