Basic Information
| Provider Information | |||||||||
| NPI: | 1306554050 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MUSTAFAYEV | ||||||||
| FirstName: | OKTAY | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13231 82ND ST | ||||||||
| Address2: | |||||||||
| City: | OZONE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114171203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3472315749 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4445 MAGNOLIA AVE | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925014135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9517883000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2022 | ||||||||
| LastUpdateDate: | 11/11/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 95304321 | CA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.