Basic Information
| Provider Information | |||||||||
| NPI: | 1174267025 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MUSTAFA | ||||||||
| FirstName: | NAILAH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 519 REBA | ||||||||
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| City: | CONVERSE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781091139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542985892 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7700 MESQUITE PASS | ||||||||
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| City: | CONVERSE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781092461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106500551 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2022 | ||||||||
| LastUpdateDate: | 04/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 122532 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.