Provider Demographics
NPI:1073213419
Name:MUSTAPHA, RAKIYA
Entity Type:Individual
Prefix:
First Name:RAKIYA
Middle Name:
Last Name:MUSTAPHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26085 SUPERIOR RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-4487
Mailing Address - Country:US
Mailing Address - Phone:202-560-4897
Mailing Address - Fax:
Practice Address - Street 1:26085 SUPERIOR RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-4487
Practice Address - Country:US
Practice Address - Phone:202-560-4897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI802991637343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)